# SOUTHEAST WISCONSIN AMBULATORY SURGICAL CENTER S C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTHEAST WISCONSIN SURGICAL SUITES SC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225153620
- **Authorized official:** CYNTHIA R CERNAK DPM (OWNER)
- **Authorized official phone:** (262) 697-4301

## Contact information

- **Practice address:** 10105 74TH ST, SUITE 102, KENOSHA, WI 53142-7519
- **Practice address phone:** (262) 697-4301
- **Practice address fax:** (262) 925-8409
- **Mailing address:** 10105 74TH ST, SUITE 102, KENOSHA, WI 53142-7519
- **Mailing address phone:** (262) 697-4301
- **Mailing address fax:** (262) 925-8409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 52D1008619 | WI | Yes |

## Other

- **Enumeration date:** 03/21/2007
- **Last updated:** 07/07/2014