Organization · Type 2 NPI

Great Lakes Surgery LLC

Ambulatory Surgical Clinic/Center · Kenosha, WI

NPI number 1629518006 Active

Practice location

6123 Green Bay Rd Ste 101
Kenosha, WI 53142-2927

Call (262) 657-0224 Map

Mailing address

6123 Green Bay Rd, Suite 100
Kenosha, WI 53142-2927

Specialties and licenses

TaxonomyCodeLicense
Ambulatory Surgical Clinic/Center Primary 261QA1903XNone listed

Ambulatory Surgical Clinic/Center: Definition to come...

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About NPI 1629518006

Great Lakes Surgery LLC's National Provider Identifier is 1629518006, issued on Mar 3, 2017. The primary taxonomy on file is Ambulatory Surgical Clinic/Center (261QA1903X), and the practice location is in Kenosha, WI. The record was last updated on Mar 3, 2017.