Provider Demographics
NPI:1861437766
Name:OMNI FAMILY MEDICAL CLINIC URGENT CARE, S.C.
Entity type:Organization
Organization Name:OMNI FAMILY MEDICAL CLINIC URGENT CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABALO
Authorized Official - Middle Name:K ELI
Authorized Official - Last Name:NUNYAKPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-586-9255
Mailing Address - Street 1:7810 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-4518
Mailing Address - Country:US
Mailing Address - Phone:414-586-9255
Mailing Address - Fax:414-586-9282
Practice Address - Street 1:7810 W GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-4518
Practice Address - Country:US
Practice Address - Phone:414-586-9255
Practice Address - Fax:414-586-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care