# PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Harley Davidson Health Center- Pilgrim Road
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770868135
- **Authorized official:** JON LEIZMAN M.D. (PRESIDENT)
- **Authorized official phone:** (216) 479-9063

## Contact information

- **Practice address:** W156 N 9000 RILGRIM RD, MENOMONEE FALLS, WI 53051
- **Practice address phone:** (262) 502-8752
- **Practice address fax:** (262) 502-8756
- **Mailing address:** 16906 COLLECTION CENTER DR, CHICAGO, IL 60693-0169
- **Mailing address phone:** (262) 502-8752
- **Mailing address fax:** (262) 502-8756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/18/2011
- **Last updated:** 08/15/2022