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Organization

GENESIS MEDICAL CENTER OF KENOSHA, S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JEAN GARRETTO (OFFICE MANAGER)
(262) 652-3500
Entity
Organization

Contact information

Practice address
1020 35TH ST, KENOSHA, WI 53140-1902
(262) 652-3500
(262) 925-8353
Mailing address
1020 35TH ST, KENOSHA, WI 53140-1902
(262) 652-3500
(262) 925-8353

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
Primary
207RR0500X
Rheumatology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
21301500
WI
Enumeration date
06/16/2006
Last updated
04/20/2008
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