Basic Information
| Provider Information | |||||||||
| NPI: | 1720149362 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILWAUKEE COUNTY BEHAVIORAL HEALTH MEDICAL ASSOCIATES PSYCH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9201 W WATERTOWN PLANK RD | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142576995 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9201 W WATERTOWN PLANK RD | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142576995 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HILL | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4142575202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 32753800 | 05 | WI | MEDICAID |