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Great Lakes Family Medical Center Inc
Clinic/Center in Kenosha, Wisconsin
NPI 1093900136

Great Lakes Family Medical Center Inc is a Clinic/Center based in Kenosha, WI. Great Lakes Family Medical Center Inc practices in Kenosha, WI. The NPI Number for Great Lakes Family Medical Center Inc is 1093900136 and holds a License No. 45606020 (Wisconsin).

The current practice location address for Great Lakes Family Medical Center Inc is 6123 Green Bay Rd, Kenosha, WI and can be reached out via phone at 262-764-4390 and via fax at 262-764-4396.

Location: 6123 Green Bay Rd, Kenosha, WI, 53142-2927
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1093900136
Provider Name
Great Lakes Family Medical Center Inc
Credential
Provider Entity Type
Organization
Address
6123 Green Bay Rd, Kenosha, WI, 53142-2927
Phone Number
262-764-4390
Fax Number
262-764-4396
Provider Enumeration Date
09/12/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
34414100 05 WI
institution
Provider Business Practice Location Address Details
Address
6123 Green Bay Rd
City
Kenosha
State
Wisconsin
Zip
53142-2927
Phone Number
262-764-4390
Fax Number
262-764-4396
person
Provider Business Mailing Address Details
Address
6123 Green Bay Rd
City
Kenosha
State
Wisconsin
Zip
53142-2927
Phone Number
262-764-4390
Fax Number
262-764-4396
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
-
Taxonomy
261Q00000X
License No.
45606020 (Wisconsin)
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., radiology, poor, and public health).
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