Great Lakes Family Medical Center Inc

NPI 1093900136 - Clinic/Center - 261Q00000X

NPI Details
NPI 1093900136
Enumeration Date 09/12/2007
Last Updated 08/26/2010
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name JAWAID JAWAID
Position PRESIDENT
Phone (262) 764-4390
Fax (262) 764-4396
Practice Location
6123 GREEN BAY RD
SUITE 120
KENOSHA WI, 53142-2927, US
Phone (262) 764-4390
Fax (262) 764-4396
Business Location
6123 GREEN BAY ROAD
SUITE 120
KENOSHA WI, 53142-2927, US
Phone (262) 764-4390
Fax (262) 764-4396
Toxanomy
Taxonomy Code 261Q00000X
License State Wisconsin
License Number 45606020
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According to our database, Great Lakes Family Medical Center Inc NPI is 1093900136, taxonomy code is 261Q00000X and license number is 45606020, license state is located at Wisconsin. Great Lakes Family Medical Center Inc physically located at 6123 Green Bay Rd, Kenosha WI, 53142-2927. NPI Number 1033115704 has the healthcare provider type.

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1093900136 NPI number is provided on an as is basis without warranty of any kind. 1093900136 is maintained by the National Plan & Provider Enumeration System. The contents of Great Lakes Family Medical Center Inc are for informational purposes only.