NPIMap

Organization Active NPI

Milwaukee Indonesia Medical Clinic

Doing business as Indonesia Medical Clinic

  • Clinic/Center
  • Milwaukee, WI
National Provider Identifier
1366814162
Registry record updated Nov 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MILWAUKEE INDONESIA MEDICAL CLINIC
Doing business as
Indonesia Medical Clinic
Practice address
6300 N 76TH St Ste 250
Milwaukee, WI 53218-1208
Phone
(414) 446-4660
NPI assigned
Oct 20, 2015
Last updated
Nov 14, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Herr Yang
Title
President
Phone
(414) 397-1654

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X
PharmacistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 183500000X
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

6300 N 76TH St Ste 250
Milwaukee, WI 53218-1208

Mailing address

6300 N 76TH St Ste 250
Milwaukee, WI 53218-1208
Phone (414) 446-4660

Other names 1

  • Indonesia Medical Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

6300 N 76th St
Ste 250
Milwaukee, WI 53218
Phone (414) 446-4660

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1366814162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 N 76TH ST STE 250",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532181208",
            "telephone_number": "414-446-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 N 76TH ST STE 250",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532181208",
            "telephone_number": "414-446-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILWAUKEE INDONESIA MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-20",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "HERR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-397-1654"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indonesia Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.