MEDICARE: CHILDREN'S MEDICAL GRUOP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	2080P0006X	Developmental - Behavioral Pediatrics Physician
3	106H00000X	Marriage & Family Therapist
4	1041C0700X	Clinical Social Worker

Other Identifiers

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

General Provider Information

NPI Number	:	1427223775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S MEDICAL GRUOP

Provider Business Mailing Address
First Line	:	9000 W WISCONSIN AVE
Second Line	:	MS 958
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4874
Country	:	US
Telephone Number	:	414-266-7615
Fax Number	:	414-266-1853

Provider Business Practice Location Address
First Line	:	6791 N GREEN BAY AVE
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3422
Country	:	US
Telephone Number	:	414-228-4800
Fax Number	:	414-228-0894

Authorized Official
Title or Position	:	PRESIDENT, CHILDREN'S MEDICAL GROUP
Name	:	DR. SMRITI KHARE
Credential	:	M.D.
Telephone Number	:	414-266-7615

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	01/19/2012

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Directions to “CHILDREN'S MEDICAL GRUOP ” Practice Location

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