| Premise Health Of Wisconsin Medical, S.c. | |
|
4303 39th Ave Kenosha WI 53144-1969 | |
| (262) 653-4444 | |
| Not Available |
| Full Name | Premise Health Of Wisconsin Medical, S.c. |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 4303 39th Ave, Kenosha, Wisconsin |
| Authorized Official Name and Position | William Wright (LEGAL COUNSEL) |
| Authorized Official Contact | 6155775893 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premise Health Of Wisconsin Medical, S.c. 5500 Maryland Way Ste 120 Brentwood TN 37027-4993 Ph: () - | Premise Health Of Wisconsin Medical, S.c. 4303 39th Ave Kenosha WI 53144-1969 Ph: (262) 653-4444 |
| NPI Number | 1760109052 |
|---|---|
| Provider Enumeration Date | 10/26/2022 |
| Last Update Date | 10/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760109052 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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Great Lakes Family Medical Center Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142 Phone: 262-764-4390 Fax: 262-764-4396 | |
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