| NPI | 1154821387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES EDWARD SAMMIS Physician/Owner 262-339-3033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 48218-21) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2021-08-25 |