GREAT LAKES FAMILY MEDICAL CENTER INC
NPI 1093900136
Clinic/Center in Kenosha, WI

Q: What is Great Lakes Family Medical Center Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Active since September 12, 2007

6123 GREEN BAY RD, SUITE 120, KENOSHA, WI 53142(262) 764-4390(262) 764-4396 Get Directions Write a Review

NPPES record last updated: August 26, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Great Lakes Family Medical Center Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES FAMILY MEDICAL CENTER INC (NPI 1093900136) is a healthcare organization registered as a clinic/center in Kenosha, Wisconsin and active in the NPI registry since September 2007. The organization lists Jawaid Quddus, President, as its authorized official.

NPPES Registry Identity

NPI1093900136

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NameGREAT LAKES FAMILY MEDICAL CENTER INC

Location Address6123 GREEN BAY RD, SUITE 120Kenosha, WI 53142-2927

Mailing Address6123 Green Bay Road, Suite 120Kenosha, WI 53142-2927 · (262) 764-4390 · Fax (262) 764-4396

Phone(262) 764-4390

Fax(262) 764-4396

Organization SubpartNo

Authorized OfficialJawaid QuddusPresident · (262) 764-4390

Enumeration DateSeptember 12, 2007

Last NPPES UpdateAugust 26, 2010

✔ NPI 1093900136 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

License✔ Licensed in WI · 45606020

Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

6123 GREEN BAY RD, Kenosha, WI 53142

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Other Identifiers 3

Medicaid34414100WI

Medicare UPINH91649WI

Medicare PIN000032057WI

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RODRIGO BUENCAMINO MATA III M.D.

Internal Medicine

6123 GREEN BAY RD, SUITE 120
KENOSHA, WI 53142

Kenosha County (262) 652-2710

MRS. TAREY ANN WENNINGER P.T.,

Physical Therapist

6123 GREEN BAY RD, SUITE 140
KENOSHA, WI 53142

Kenosha County (262) 653-9208

RODRIGO A MATA JR. M.D.

Family Medicine

6123 GREEN BAY RD, SUITE 120
KENOSHA, WI 53142

Kenosha County (262) 652-6995

GREAT LAKES FOOT & ANKLE CENTERS INC

Podiatrist (Foot & Ankle Surgery)

6123 GREEN BAY RD, SUITE 100
KENOSHA, WI 53142

Kenosha County (262) 652-3668

DR THOMAS J SOLECKI JR SC

Chiropractor

6123 GREEN BAY RD, SUITE 140
KENOSHA, WI 53142

Kenosha County (262) 653-9208

DR. KALPANA RAO PHD

Psychologist (Clinical)

6123 GREEN BAY RD
KENOSHA, WI 53142

Kenosha County (262) 948-1000

TODD'S COMPANIONPLUS, INC.

Home Health

6123 GREEN BAY RD, SUITE 230
KENOSHA, WI 53142

Kenosha County (262) 842-0405

GREAT LAKES SURGERY CENTER LLC

Clinic/Center (Ambulatory Surgical)

6123 GREEN BAY RD, SUITE 100
KENOSHA, WI 53142

Kenosha County (262) 657-3668

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Great Lakes Family Medical Center Inc's NPI number?

The NPI number for Great Lakes Family Medical Center Inc is 1093900136. It was assigned to this organization in the NPPES registry on September 12, 2007.

Where is Great Lakes Family Medical Center Inc located?

Great Lakes Family Medical Center Inc is located at 6123 Green Bay Rd Suite 120, Kenosha, WI 53142. The listed phone number is (262) 764-4390.

What is Great Lakes Family Medical Center Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for Great Lakes Family Medical Center Inc was last updated on August 26, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.