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Organization
GREEN BAY ROAD MEDICAL SERVICES INC
Active
Organization
GREEN BAY ROAD MEDICAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN C. MATTEUCCI JR. M.D. (FACILITY DIRECTOR)
(262) 653-9221
Entity
Organization
Contact information
Practice address
6127 GREEN BAY ROAD, SUITE 600, KENOSHA, WI 53142-2930
(262) 653-9221
(262) 653-9229
Mailing address
6127 GREEN BAY ROAD, SUITE 600, KENOSHA, WI 53142-2930
(262) 653-9221
(262) 653-9229
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
08/17/2010
Last updated
08/17/2010
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