Provider Demographics
NPI:1609464049
Name:PROGRESSIVE MEDICAL GROUP
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASVIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:414-251-3500
Mailing Address - Street 1:9120 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1622
Mailing Address - Country:US
Mailing Address - Phone:414-251-3500
Mailing Address - Fax:414-251-3504
Practice Address - Street 1:9120 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1622
Practice Address - Country:US
Practice Address - Phone:414-215-3500
Practice Address - Fax:414-215-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-31
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7171-33OtherSTATE LICENSE