Milwaukee Midwest Medical Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MILWAUKEE MIDWEST MEDICAL LAB

Practice address

756 N 35TH St Ste 103
Milwaukee, WI 53208-3360

Phone

(414) 342-8463

NPI assigned

May 1, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Phillip Thong

Title

Manager

Phone

(414) 342-8463

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508087974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "756 N 35TH ST STE 103",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532083360",
            "telephone_number": "414-342-8463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "756 N 35TH ST STE 103",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532083360",
            "telephone_number": "414-342-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILWAUKEE MIDWEST MEDICAL LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THONG",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "414-342-8463",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32931800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Milwaukee, WI
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• Clinical Medical Laboratory in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.