# KENOSHA SURGICENTER LLC

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

## Provider details

- **NPI number:** 1669111274
- **Authorized official:** MR. RUSSEL LEIN JD (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (414) 531-4327

## Contact information

- **Practice address:** 10105 74TH ST STE 102, KENOSHA, WI 53142-7530
- **Practice address phone:** (262) 297-7246
- **Mailing address:** 2500 W LAYTON AVE STE 120, MILWAUKEE, WI 53221-5400
- **Mailing address phone:** (262) 297-7246

## Taxonomy

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

## Other

- **Enumeration date:** 06/01/2022
- **Last updated:** 06/08/2022