Basic Information
| Provider Information | |||||||||
| NPI: | 1760674675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOUVAR-CANGA | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LOUVAR | ||||||||
| OtherFirstName: | CLAIRE | ||||||||
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| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4455 S 108TH ST | ||||||||
| Address2: | GREENFIELD HIGHLANDS WALK-IN CLINIC | ||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532282504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144275350 | ||||||||
| FaxNumber: | 4144275311 | ||||||||
| Practice Location | |||||||||
| Address1: | 4455 S 108TH ST | ||||||||
| Address2: | GREENFIELD HIGHLANDS WALK-IN CLINIC | ||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532282504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144275350 | ||||||||
| FaxNumber: | 4144275311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 12/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 42294 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1760674675 | 05 | WI | MEDICAID |