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NPI Code Detail

MEDICARE: GENESIS MEDICAL CENTER OF KENOSHA, S.C.

MEDICARE: GENESIS MEDICAL CENTER OF KENOSHA, S.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician
2207RR0500XRheumatology Physician
3207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063456424
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESIS MEDICAL CENTER OF KENOSHA, S.C.
Provider Business Mailing Address
First Line : 1020 35TH ST
Second Line :
City : KENOSHA
State : WI
Zip : 53140-1902
Country : US
Telephone Number : 262-652-3500
Fax Number : 262-925-8353
Provider Business Practice Location Address
First Line : 1020 35TH ST
Second Line :
City : KENOSHA
State : WI
Zip : 53140-1902
Country : US
Telephone Number : 262-652-3500
Fax Number : 262-925-8353
Authorized Official
Title or Position : OFFICE MANAGER
Name : JEAN GARRETTO
Credential :
Telephone Number : 262-652-3500
Provider Enumeration Date : 06/16/2006
Last Update Date : 04/20/2008

Similar Medicare Providers

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Practice Location Address:
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1972547040 — SHAZIA MIRZA M.D.
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1598906596 — MS. ALYSSA SKALITZKY APNP
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1487178984 — FAMILY PSYCHIATRIC CARE, LLC
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1275142796 — CHRISTINE MARIE TURCOTTE APNP
Practice Location Address:
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1497493845 — ALEXANDRIA COLLEEN DATTILO APNP
Practice Location Address:
1010 35TH ST
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Practice Phone: 262-725-4426
Practice Fax: 262-299-7136

Directions to “GENESIS MEDICAL CENTER OF KENOSHA, S.C. ” Practice Location

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