| NPI | 1922441195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY OSBOURNE Owner 262-691-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 122300000X Dentist | |
| 124Q00000X Dental Hygienist | |
| 126800000X Dental Assistant | |
| 152W00000X Optometrist | |
| 207N00000X Dermatology | |
| 2085R0202X Radiology Diagnostic Radiology | |
| 213E00000X Podiatrist | |
| 224L00000X Pedorthist | |
| 225100000X Physical Therapist | |
| 231H00000X Audiologist | |
| 237700000X Hearing Instrument Specialist | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2013-04-08 |