Healthcare Provider Details

I. General information

NPI: 1831855444
Provider Name (Legal Business Name): THE SLM GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W FOND DU LAC AVE
MILWAUKEE WI
53206-5320
US

IV. Provider business mailing address

6030 W GREENFIELD AVE
WEST ALLIS WI
53214-5001
US

V. Phone/Fax

Practice location:
  • Phone: 414-499-9241
  • Fax:
Mailing address:
  • Phone: 414-671-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARQUIS A YOUNG SR.
Title or Position: PRESIDENT
Credential:
Phone: 262-893-0859