Menominee Indian Tribe of Wisconsin

NPI #1568404721 in Keshena, Wisconsin

Provider Information

NPI Number: 1568404721
Entity Type: Organization
Organization Name: Menominee Indian Tribe of Wisconsin
Primary Specialty: Family Medicine
Enumeration Date: Jun 12, 2006
Last Updated: Apr 2, 2019

Practice Location

Address: W3275 WOLF RIVER ROAD
City: Keshena
State: Wisconsin
ZIP Code: 54135
Phone: (715) 799-3361

Authorized Official

Name: JERRY L WAUKAU SR.
Title: HEALTH ADMINISTRATOR
Phone: (715) 799-3361

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Federally Qualified Health Center (FQHC) — Federally Qualified Health Center (FQHC)	261QF0400X
Family Medicine	207Q00000X	Primary

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