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Organization
WEST BEND CLINIC, INC.
Active
Organization
WEST BEND CLINIC, INC.
Active
Other names
West Bend Clinic East
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY G BLOMMEL (ADMINISTRATOR)
(262) 334-3451
Entity
Organization
Contact information
Practice address
1190 E PARADISE DR, WEST BEND, WI 53095-5444
(262) 306-6319
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21251400
—
WI
Enumeration date
08/08/2006
Last updated
05/23/2012
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