Great Lakes Family Medical Center Inc in Kenosha - Clinic/center
Great Lakes Family Medical Center Inc - NPI 1093900136
Great Lakes Family Medical Center Inc is a Clinic/center in Kenosha, Wisconsin. Great Lakes Family Medical Center Inc practices all healthcare services and medical treatments related to Clinic/center. The NPI Number for Great Lakes Family Medical Center Inc is 1093900136. The last update date is 2010-08-26.
Great Lakes Family Medical Center Inc's current location address is 6123 Green Bay Road, Kenosha, Wisconsin. You can contact this provider via phone number 2627644390 and fax number 2627644396. The mailing address for Great Lakes Family Medical Center Inc is 6123 Green Bay Road, Kenosha, Wisconsin. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Great Lakes Family Medical Center Inc |
|---|---|
| Address | 6123 Green Bay Road, Kenosha, Wisconsin |
| Phone Number | 2627644390 |
| Fax Number | 2627644396 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PRESIDENT |
|---|---|
| Authorized Official Name | Quddus Jawaid |
| Credentials | M.D., PH.D |
| Telephone Number | 2627644390 |
NPI Number Detail
| NPI Number | 1093900136 |
|---|---|
| Provider Enumeration Date | 2007-09-12 |
| Last Updated Date | 2010-08-26 |
Provider Mailing Address Detail
| Address | 6123 Green Bay Road |
|---|---|
| City | Kenosha |
| State | Wisconsin (WI) |
| Post Code | 531422927 |
| Phone Number | 2627644390 |
| Fax Number | 2627644396 |
Provider's Primary Taxonomy Detail
| Speciality | Clinic/center |
|---|---|
| Taxonomy | 261Q00000X |
| Licence No | 45606020 |
|
Definition: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 34414100 | WI | -- |
Post Comment/ Review Below
What is the unique 10-digit identification code issued to Great Lakes Family Medical Center Inc by the Centers for Medicare & Medicaid Services?
The Great Lakes Family Medical Center Inc has been assigned the NPI (National Provider Identifier) 1093900136 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Could you kindly provide the complete physical address where Great Lakes Family Medical Center Inc's facilities are geographically located?
The facilities of Great Lakes Family Medical Center Inc are physically situated at the following location: 6123 Green Bay Road, Kenosha, WI, 531422927.
What is Great Lakes Family Medical Center Inc's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Great Lakes Family Medical Center Inc is Clinic/center, and the taxonomy code that categorizes this field of expertise is 261Q00000X.
On what date did the Centers for Medicare & Medicaid Services issue the 1093900136 to Great Lakes Family Medical Center Inc?
The Great Lakes Family Medical Center Inc received its 1093900136 assignment from the Centers for Medicare & Medicaid Services on 2007-09-12.
When was the information related to Great Lakes Family Medical Center Inc most recently updated or refreshed?
The details pertaining to the Great Lakes Family Medical Center Inc, including its address, specialty, and other relevant information, were last updated or refreshed on 2010-08-26.
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