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General NPI Number Information
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NPI Number | 1033288816
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN MEDICAL CENTER SC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 1532 S GREEN BAY RD SUITE 200
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City | RACINE
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State | WI
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Zip | 53406-4410
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Country | US
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Telephone | 262-631-0474
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Fax | 262-631-0476
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Provider Business Mailing Address
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Address Line | 1532 S GREEN BAY RD SUITE 200
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City | RACINE
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State | WI
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Zip | 53406-4410
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Country | US
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Telephone | 262-631-0474
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Fax | 262-631-0476
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH J KURT
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Credential | DO
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Telephone | 262-631-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14968021
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License Number State | WI
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