Provider Demographics
NPI:1861240103
Name:SOLIDARITUS HEALTH WISCONSIN SC
Entity type:Organization
Organization Name:SOLIDARITUS HEALTH WISCONSIN SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-304-6764
Mailing Address - Street 1:1025 CONNECTICUT AVE NW STE 907
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5434
Mailing Address - Country:US
Mailing Address - Phone:888-491-2951
Mailing Address - Fax:
Practice Address - Street 1:615 PENNSYLVANIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4664
Practice Address - Country:US
Practice Address - Phone:920-547-4210
Practice Address - Fax:800-671-5786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLIDARITUS HEALTH WISCONSIN SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-10
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty