| Green Lake Medical Clinic , S.c. | |
|
N6205 Busse Drive Green Lake WI 54941 | |
| (920) 294-3444 | |
| (920) 294-6660 |
| Full Name | Green Lake Medical Clinic , S.c. |
|---|---|
| Speciality | Family Medicine |
| Location | N6205 Busse Drive, Green Lake, Wisconsin |
| Authorized Official Name and Position | Thomas Rice Willett (PRESIDENT) |
| Authorized Official Contact | 9202943444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Lake Medical Clinic , S.c. N6205 Busse Drive Po Box 429 Green Lake WI 54941 Ph: (920) 294-3444 | Green Lake Medical Clinic , S.c. N6205 Busse Drive Green Lake WI 54941 Ph: (920) 294-3444 |
| NPI Number | 1306986716 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306986716 | NPI | - | NPPES |
| 30071600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 17659 (Wisconsin) | Primary |
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