| West Grove Clinic, Sc | |
|
10012 W. Capitol Dr. #101 Wauwatosa WI 53222-1300 | |
| (414) 810-4844 | |
| (414) 810-4845 |
| Full Name | West Grove Clinic, Sc |
|---|---|
| Speciality | Clinic/center |
| Location | 10012 W. Capitol Dr. #101, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Selahattin S. Kurter (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4148104844 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Grove Clinic, Sc 10012 W. Capitol Dr #101 Wauwatosa WI 53222-1300 Ph: (414) 810-4844 | West Grove Clinic, Sc 10012 W. Capitol Dr. #101 Wauwatosa WI 53222-1300 Ph: (414) 810-4844 |
| NPI Number | 1518167477 |
|---|---|
| Provider Enumeration Date | 07/19/2007 |
| Last Update Date | 10/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518167477 | NPI | - | NPPES |
| 42229100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2318 (Wisconsin) | Primary |
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