| |
4005 Community Center Dr Weston WI 54476-4139 | |
(715) 241-5400 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 4005 Community Center Dr, Weston, Wisconsin |
Authorized Official Name and Position | Jerry M Yang (SVP & CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 7158472526 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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29980 Network Pl Chicago IL 60673-1299 Ph: (715) 847-2304 | 4005 Community Center Dr Weston WI 54476-4139 Ph: (715) 241-5400 |
NPI Number | 1700116084 |
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Provider Enumeration Date | 01/08/2010 |
Last Update Date | 06/12/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700116084 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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