=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770371650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARRETTO MEDICAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2025
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1328 41ST AVE
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53144-2984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-945-0080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1328 41ST AVE
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53144-2984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-945-0080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | GIUSEPPE GARRETTO
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 262-945-0080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------