1205611852 NPI number — OSL 3553 MILWAUKEE OPERATING LLC

Table of content: (NPI 1205611852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205611852 NPI number — OSL 3553 MILWAUKEE OPERATING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSL 3553 MILWAUKEE OPERATING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205611852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2448 S 102ND ST STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ALLIS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53227-2141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-214-8950
Provider Business Mailing Address Fax Number:
414-755-1315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3553 S 41ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53221-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-649-0730
Provider Business Practice Location Address Fax Number:
414-831-1188
Provider Enumeration Date:
08/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
TERESINSKI
Authorized Official First Name:
MATT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
414-324-5172

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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