# GREAT MIDWEST MEDICAL, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629356423
- **Authorized official:** DR. ROBERT DONALD MATTEUCCI D.P.M. (PRESIDENT)
- **Authorized official phone:** (262) 945-1094

## Contact information

- **Practice address:** 17495 W CAPITOL DR, UNIT K, BROOKFIELD, WI 53045-2059
- **Practice address phone:** (262) 945-1094
- **Mailing address:** 17495 W CAPITOL DR, UNIT K, BROOKFIELD, WI 53045-2059
- **Mailing address phone:** (262) 945-1094

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/27/2011
- **Last updated:** 12/07/2011