| Great Lakes Family Medical Center Inc | |
|
6123 Green Bay Rd Suite 120 Kenosha WI 53142-2927 | |
| (262) 764-4390 | |
| (262) 764-4396 |
| Full Name | Great Lakes Family Medical Center Inc |
|---|---|
| Speciality | Clinic/center |
| Location | 6123 Green Bay Rd, Kenosha, Wisconsin |
| Authorized Official Name and Position | Jawaid Quddus (PRESIDENT) |
| Authorized Official Contact | 2627644390 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Family Medical Center Inc 6123 Green Bay Road Suite 120 Kenosha WI 53142-2927 Ph: (262) 764-4390 | Great Lakes Family Medical Center Inc 6123 Green Bay Rd Suite 120 Kenosha WI 53142-2927 Ph: (262) 764-4390 |
| NPI Number | 1093900136 |
|---|---|
| Provider Enumeration Date | 09/12/2007 |
| Last Update Date | 08/26/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093900136 | NPI | - | NPPES |
| 34414100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 45606020 (Wisconsin) | Primary |
Steven Schwimmer, Do Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5455 Sheridan Rd, 201, Kenosha, WI 53140 Phone: 262-654-2500 Fax: 252-654-2701 | |
Leilane U Sta Romana Mdsc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3734 7th Ave, Dominican Building Suite 15, Kenosha, WI 53140 Phone: 262-658-3706 | |
Surya Medical Group Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6125 Green Bay Rd, Suite 100, Kenosha, WI 53142 Phone: 262-564-8636 | |
Genesis Medical Center Of Kenosha, S.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1020 35th St, Kenosha, WI 53140 Phone: 262-652-3500 Fax: 262-925-8353 | |
Gevinah Healthcare Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3100 Washington Rd, Kenosha, WI 53144 Phone: 310-933-5688 | |
Regina Capelli-scheidt M.d,s.c Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3601 30th Ave, Kenosha, WI 53144 Phone: 262-658-8862 Fax: 262-658-8874 |