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General NPI Number Information
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NPI Number | 1518167477
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Entity Type | Organization
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Legal Business Name | WEST GROVE CLINIC, SC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 10012 W. CAPITOL DR. #101
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City | WAUWATOSA
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State | WI
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Zip | 53222-1300
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Country | US
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Telephone | 414-810-4844
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Fax | 414-810-4845
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Provider Business Mailing Address
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Address Line | 10012 W. CAPITOL DR #101
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City | WAUWATOSA
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State | WI
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Zip | 53222-1300
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Country | US
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Telephone | 414-810-4844
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Fax | 414-810-4845
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SELAHATTIN S. KURTER
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Credential | MD
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Telephone | 414-810-4844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2318
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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