Provider Demographics
NPI:1629373204
Name:KENOSHA URGICARE
Entity Type:Organization
Organization Name:KENOSHA URGICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FUAD
Authorized Official - Middle Name:SHIHAB
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:262-925-0535
Mailing Address - Street 1:6430 S GREEN BAY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142
Mailing Address - Country:US
Mailing Address - Phone:262-925-0535
Mailing Address - Fax:262-925-0538
Practice Address - Street 1:6430 S GREEN BAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142
Practice Address - Country:US
Practice Address - Phone:262-925-0535
Practice Address - Fax:262-925-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care