GREAT LAKES SURGERY LLC NPI 1629518006

NPI Information

NPI: 1629518006
Provider Name: GREAT LAKES SURGERY LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
6123 GREEN BAY RD STE 101
KENOSHA, WI
ZIP 53142
Phone: (262) 657-0224
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GREAT LAKES SURGERY LLC is an ambulatory surgical clinic center in Kenosha, WI. GREAT LAKES SURGERY LLC NPI is 1629518006. The provider is registered as an organization entity type.

The provider's business location address is:

6123 GREEN BAY RD STE 101
KENOSHA, WI
ZIP 53142-927
Phone: (262) 657-0224

The provider's authorized official is John L Bostanche .
The authorized official title is Director and has the following contact phone number (262) 657-0224.

The enumeration date for this NPI number is 3/3/2017 and was last updated on 3/3/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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