is a Primary Care in Kenosha, Wisconsin. practices all healthcare services and medical treatments related to Primary Care. The NPI Number for is 1669682282. The last update date is .
's current location address is 5027 Green Bay Rd, Kenosha, Wisconsin. You can contact this provider via phone number 2629258600 and fax number 2629258599. The mailing address for is 5027 Green Bay Rd, Kenosha, Wisconsin. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 5027 Green Bay Rd, Kenosha, Wisconsin |
| Phone Number | 2629258600 |
| Fax Number | 2629258599 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1669682282 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 5027 Green Bay Rd |
|---|---|
| City | Kenosha |
| State | Wisconsin (WI) |
| Post Code | 531441771 |
| Phone Number | 2629258600 |
| Fax Number | 2629258599 |
Provider's Primary Taxonomy Detail
| Speciality | Primary Care |
|---|---|
| Taxonomy | 261Qp2300X |
| Licence No | 2671 |
|
Definition: Serves as the first point of contact for comprehensive healthcare services. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1669682282 | WI | -- |
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