GREAT LAKES SURGERY LLC
NPI 1629518006
Clinic/Center - Ambulatory Surgical in Kenosha, WI

Q: What is Great Lakes Surgery LLC's NPI number?

The NPI number for Great Lakes Surgery LLC is 1629518006. It was assigned to this organization in the NPPES registry on March 3, 2017.

Q: What is Great Lakes Surgery LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Active since March 03, 2017

6123 GREEN BAY RD STE 101, KENOSHA, WI 53142(262) 657-0224 Get Directions Write a Review

NPPES record last updated: March 3, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Great Lakes Surgery Llc NPPES

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

GREAT LAKES SURGERY LLC (NPI 1629518006) is a healthcare organization registered as an ambulatory surgical in Kenosha, Wisconsin and active in the NPI registry since March 2017. The organization lists John L Bostanche, Director, as its authorized official.

NPPES Registry Identity

NPI1629518006

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NameGREAT LAKES SURGERY LLC

Location Address6123 GREEN BAY RD STE 101Kenosha, WI 53142-2927

Mailing Address6123 Green Bay Rd, Suite 100Kenosha, WI 53142-2927 · (262) 657-0224

Phone(262) 657-0224

Organization SubpartNo

Authorized OfficialJohn L BostancheDirector · (262) 657-0224

Enumeration DateMarch 3, 2017

✔ NPI 1629518006 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

6123 GREEN BAY RD STE 101, Kenosha, WI 53142

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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 Surgery LLC's NPI number?

The NPI number for Great Lakes Surgery LLC is 1629518006. It was assigned to this organization in the NPPES registry on March 3, 2017.

Where is Great Lakes Surgery LLC located?

Great Lakes Surgery LLC is located at 6123 Green Bay Rd Ste 101, Kenosha, WI 53142. The listed phone number is (262) 657-0224.

What is Great Lakes Surgery LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

When was this NPI record last updated?

The NPPES record for Great Lakes Surgery LLC was last updated on March 3, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.