MEDICARE: CHILDREN'S MEDICAL GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	103TC2200X	Clinical Child & Adolescent Psychologist
4	104100000X	Social Worker
5	1041C0700X	Clinical Social Worker
6	106H00000X	Marriage & Family Therapist
7	2084P0800X	Psychiatry Physician
8	2084P0804X	Child & Adolescent Psychiatry Physician
9	208000000X	Pediatrics Physician

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	:	1710152954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S MEDICAL GROUP

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	:	4655 N PORT WASHINGTON RD STE 200
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53212-1076
Country	:	US
Telephone Number	:	414-247-9530
Fax Number	:	414-247-1875

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	09/27/2021

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Directions to “CHILDREN'S MEDICAL GROUP ” Practice Location

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