Organization
GREEN BAY ROAD MEDICAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN C. MATTEUCCI JR. M.D. (FACILITY DIRECTOR)
(262) 653-9221
Entity
Organization
Contact information
Practice address
6127 GREEN BAY ROAD, SUITE 600, KENOSHA, WI 53142-2930
(262) 653-9221
(262) 653-9229
Mailing address
6127 GREEN BAY ROAD, SUITE 600, KENOSHA, WI 53142-2930
(262) 653-9221
(262) 653-9229
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/17/2010
Last updated
08/17/2010
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