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General NPI Number Information
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NPI Number | 1578650164
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Entity Type | Organization
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Legal Business Name | EAR NOSE AND THROAT FAMILY CLINIC OF WISCONSIN SC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 6127 GREEN BAY RD SUITE 100
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City | KENOSHA
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State | WI
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Zip | 53142-2946
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Country | US
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Telephone | 262-652-2887
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Fax | 262-652-0547
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Provider Business Mailing Address
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Address Line | 6127 GREEN BAY RD SUITE 100
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City | KENOSHA
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State | WI
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Zip | 53142-2946
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Country | US
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Telephone | 262-652-2887
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Fax | 262-652-0547
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Authorized Official
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Title or Position | MD PRESIDENT
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Name | HILEL SWERDLIN
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Credential | MD
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Telephone | 262-652-2887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | WI
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