| Childrens Medical Group Inc | |
|
9000 W Wisconsin Ave Ms 958 Milwaukee WI 53226-3518 | |
| (414) 266-7615 | |
| (414) 266-6238 |
| Full Name | Childrens Medical Group Inc |
|---|---|
| Speciality | Pediatrics |
| Location | 9000 W Wisconsin Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Smriti Khare (PRESIDENT) |
| Authorized Official Contact | 4142666404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Childrens Medical Group Inc 9000 W Wisconsin Ave Ms 958 Milwaukee WI 53226-3518 Ph: (414) 266-7615 | Childrens Medical Group Inc 9000 W Wisconsin Ave Ms 958 Milwaukee WI 53226-3518 Ph: (414) 266-7615 |
| NPI Number | 1790732410 |
|---|---|
| Provider Enumeration Date | 05/28/2006 |
| Last Update Date | 05/14/2013 |
| Medicare PECOS PAC ID | 4981509742 |
|---|---|
| Medicare Enrollment ID | O20031204000573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790732410 | NPI | - | NPPES |
| 1790732410 | Medicaid | WI |
| Provider Name | David E Melbye |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1487640918 PECOS PAC ID: 8921054370 Enrollment ID: I20050329000475 |
| Provider Name | Sharyl G Paley |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356334817 PECOS PAC ID: 0648207670 Enrollment ID: I20050721000536 |
| Provider Name | Kristin D Bencik Boudreau |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588660195 PECOS PAC ID: 4688601628 Enrollment ID: I20050721000587 |
| Provider Name | Kristin A Haglund |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972640068 PECOS PAC ID: 1557461209 Enrollment ID: I20070710000614 |
| Provider Name | Sadoun I Omari |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1013902121 PECOS PAC ID: 6709936685 Enrollment ID: I20090616000096 |
| Provider Name | William C Leach |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1124013891 PECOS PAC ID: 6204988991 Enrollment ID: I20090709000701 |
| Provider Name | Roxanne J Kane |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1639164908 PECOS PAC ID: 8325943137 Enrollment ID: I20100119000458 |
| Provider Name | Karen M Wegner |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1063419760 PECOS PAC ID: 9739221466 Enrollment ID: I20100119000536 |
| Provider Name | Tia C Medley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609182161 PECOS PAC ID: 5395927552 Enrollment ID: I20110309000172 |
| Provider Name | Kelly S Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023395118 PECOS PAC ID: 1052587763 Enrollment ID: I20111230000325 |
| Provider Name | Ella T Jah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962739375 PECOS PAC ID: 6406092089 Enrollment ID: I20130426000569 |
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