| NPI | 1235106311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY G BLOMMEL Medical Director 262-306-6336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207V00000X Obstetrics & Gynecology | |
| 208800000X Urology | |
| 207X00000X Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 208000000X Pediatrics | |
| 207W00000X Ophthalmology | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 2085U0001X Radiology, Diagnostic Ultrasound | |
| 208600000X Surgery | |
| 152W00000X Optometrist | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2011-05-04 |