| NPI | 1023543519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN JAMES WOODS Owner 262-444-3608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| 2083B0002X Preventive Medicine, Obesity Medicine | |
| 208600000X Surgery | |
| 208D00000X General Practice | |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| 246YC3302X Spec/Tech, Health Info, Coding Specialist, Physician Office Based | |
| 261Q00000X Clinic/Center (Licence: WI 51230-20) | |
| Enumeration Date | 2017-04-22 |
| Last Update Date | 2021-04-08 |