GREAT LAKES FAMILY MEDICAL CENTER INC (NPI# 1093900136) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093900136 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES FAMILY MEDICAL CENTER INC |
| Practice Address |
6123 Green Bay Rd Suite 120 Kenosha WI 53142-2927 |
| Mailing Address |
6123 Green Bay Road Suite 120 Kenosha WI 53142-2927 |
| Practice Telephone | 2627644390 |
| Practice Fax Number | 2627644396 |
| Mailing Telephone | 2627644390 |
| Mailing Fax Number | 2627644396 |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2010-08-26 |
| Authorized Official Name | DR. JAWAID QUDDUS (PRESIDENT) |
| Authorized Official Telephone | 2627644390 |
| Authorized Official Credential | M.D., PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 45606020 | WI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 34414100 | 05 |
| Street Address |
6123 GREEN BAY RD SUITE 120 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-2927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821092420 | John L Bostanche | Podiatrist | 6123 Green Bay Rd, Ste 100, Kenosha, WI 53142-2939 | 2005-06-10 |
| 1770842213 | Todd's Companionplus Inc. | In Home Supportive Care | 6123 Green Bay Rd, Suite 250, Kenosha, WI 53142-2927 | 2012-05-03 |
| 1104127372 | Rodrigo A Mata Jr. | Family Medicine | 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142-2927 | 2010-11-04 |
| 1720303332 | Chad E Sloden | Chiropractor | 6123 Green Bay Rd, Kenosha, WI 53142-2927 | 2010-04-07 |
| 1700045168 | Great Lakes Surgery Center LLC | Clinic/Center | 6123 Green Bay Rd, Suite 100, Kenosha, WI 53142-2927 | 2008-06-02 |
| 1295941409 | Great Lakes Foot & Ankle Centers Inc | Podiatrist | 6123 Green Bay Rd, Suite 100, Kenosha, WI 53142-2927 | 2007-05-15 |
| 1053468397 | Tarey Ann Wenninger | Physical Therapist | 6123 Green Bay Rd, Suite 140, Kenosha, WI 53142-2927 | 2007-01-05 |
| 1649291923 | Kalpana Rao | Psychologist | 6123 Green Bay Rd, Kenosha, WI 53142-2927 | 2006-07-21 |
| 1033148176 | Rodrigo Buencamino Mata IIi | Internal Medicine | 6123 Green Bay Rd, Suite 120, Kenosha, WI 53142-2927 | 2006-07-01 |
| 1801882451 | Back-in-action Physical Therapy Center of Kenosha, Ltd. | Physical Therapist | 6123 Green Bay Rd, Ste 140, Kenosha, WI 53142-2927 | 2005-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275159147 | American Current Care P.a. | Clinic/Center | 6302 75th St, Kenosha, WI 53142-3506 | 2020-06-17 |
| 1144638065 | Sozo Chiropractic | Clinic/Center | 3720 72nd Ave, Kenosha, WI 53144-7300 | 2014-07-23 |
| 1356942593 | Enhance Rehabilitation | Clinic/Center | 8633 32nd Ave, Kenosha, WI 53142-5187 | 2020-11-04 |
| 1699079079 | Chiropractic Associatess of Kenosha A S C | Clinic/Center | 3120 80th St, Kenosha, WI 53142-4946 | 2010-12-29 |
| 1558305284 | Froedtert South, Inc. | Clinic/Center | 6308 8th Ave, Kenosha, WI 53143 | 2006-06-15 |
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| 1437757986 | Wonderland Therapy LLC | Clinic/Center | 2116 Winnebago St, La Crosse, WI 54601-5060 | 2020-10-15 |
| 1124633870 | Aspirus Riverview Hospital & Clinics, Inc. | Clinic/Center | 146 N Central Ave, Marshfield, WI 54449-2173 | 2020-09-10 |
| 1952915639 | Gundersen Clinic Ltd | Clinic/Center | 2615 George St, La Crosse, WI 54603-1670 | 2020-09-01 |
| 1194337212 | Accident and Injury Rehab Center, Inc | Clinic/Center | 6114 W Capitol Dr Ste 100-102, Milwaukee, WI 53216-2147 | 2020-08-19 |
| 1326683749 | A.b.d.h. Counseling Services LLC | Clinic/Center | 518 E Concordia Avenue, Milwaukee, WI 53212 | 2019-11-08 |
| 1598318818 | Acorn Dietetics, LLC | Clinic/Center | 906 10th Ave, New Glarus, WI 53574-9765 | 2019-07-17 |
| 1205493582 | Freedom Family Chiropractic | Clinic/Center | 809 Phillips Blvd, Sauk City, WI 53583-1313 | 2019-05-22 |
| 1376001578 | Lowtwillc | Clinic/Center | 2323 N Mayfair Rd Ste 104, Wauwatosa, WI 53226-1506 | 2019-03-06 |
| 1154889749 | Positive Directions Inc | Clinic/Center | 3510 W Saint Paul Ave # 6, Milwaukee, WI 53208-4125 | 2019-03-04 |
| 1144784174 | Bluestem Acupuncture | Clinic/Center | 715 Hill St Ste 130, Madison, WI 53705-3572 | 2019-01-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.