| Gevinah Healthcare Sc | |
|
3100 Washington Rd Kenosha WI 53144-1604 | |
| (310) 933-5688 | |
| Not Available |
| Full Name | Gevinah Healthcare Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 3100 Washington Rd, Kenosha, Wisconsin |
| Authorized Official Name and Position | Michael Farah (OWNER) |
| Authorized Official Contact | 3109335688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gevinah Healthcare Sc 9171 Wilshire Blvd Ste 500 Beverly Hills CA 90210-5536 Ph: (310) 933-5688 | Gevinah Healthcare Sc 3100 Washington Rd Kenosha WI 53144-1604 Ph: (310) 933-5688 |
| NPI Number | 1134907173 |
|---|---|
| Provider Enumeration Date | 09/20/2023 |
| Last Update Date | 09/20/2023 |
| Medicare PECOS PAC ID | 2567904493 |
|---|---|
| Medicare Enrollment ID | O20240607000021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134907173 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Amy E Bjorkman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588224919 PECOS PAC ID: 2860722170 Enrollment ID: I20191001000024 |
| Provider Name | Zaza Uziyel Atanelov |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487188116 PECOS PAC ID: 7810327855 Enrollment ID: I20240607000051 |
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