Provider Demographics
NPI:1831855444
Name:THE SLM GROUP
Entity type:Organization
Organization Name:THE SLM GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARQUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:262-893-0859
Mailing Address - Street 1:6030 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-5001
Mailing Address - Country:US
Mailing Address - Phone:414-671-9095
Mailing Address - Fax:
Practice Address - Street 1:2600 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-5320
Practice Address - Country:US
Practice Address - Phone:414-499-9241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical