| NPI | 1013769363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOREN LESHAN Owner 414-217-3847 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2024-04-02 |