| NPI | 1518976919 |
|---|---|
| Other Name | KEWASKUM CLINIC |
| Entity Type | Organization |
| Authorized Contact | GREGORY G BLOMMEL Medical Director 262-334-3451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| 2085B0100X Radiology, Body Imaging | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-05-23 |