Organization
NORTHWESTERN MEDICAL CENTER SC
Active
Other names
Mr Pleasant Medical Center SC Innovative Health Providers
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH J KURT DO (PRESIDENT)
(262) 631-0474
Entity
Organization
Contact information
Practice address
1532 S GREEN BAY RD, SUITE 200, RACINE, WI 53406-4410
(262) 631-0474
(262) 631-0476
Mailing address
1532 S GREEN BAY RD, SUITE 200, RACINE, WI 53406-4410
(262) 631-0474
(262) 631-0476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14968021
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30038200
—
WI
01
—
38736439001
BCBS
—
Enumeration date
11/07/2006
Last updated
12/03/2007
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