MEDICARE: GLSD MEDICAL LLC

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
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1548679046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLSD MEDICAL LLC

Provider Business Mailing Address
First Line	:	225 S EXECUTIVE DR
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8153 S 27TH ST
Second Line	:	SUITE 500
City	:	FRANKLIN
State	:	WI
Zip	:	53132-9549
Country	:	US
Telephone Number	:	414-761-1802
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS MILOSAVLJEVIC
Credential	:	MD
Telephone Number	:	414-761-1802

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	08/08/2014

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Directions to “GLSD MEDICAL LLC ” Practice Location

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