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General NPI Number Information
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NPI Number | 1588839724
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEDICAL GROUP
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 13950 W CAPITOL DR SUITE 200
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City | BROOKFIELD
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State | WI
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Zip | 53005-2441
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Country | US
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Telephone | 262-781-3065
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Fax | 262-781-3835
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE MS 958
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-7615
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Fax | 414-266-1853
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Authorized Official
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Title or Position | PRESIDENT, CHILDREN'S MEDICAL GROUP
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Name | DR. SMRITI KHARE
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Credential | MD
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Telephone | 414-266-7615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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