Organization
TRI COUNTY MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY KHAN (PRESIDENT)
(262) 697-3668
Entity
Organization
Contact information
Practice address
4310 W CRYSTAL LAKE RD, SUITE F, MCHENRY, IL 60050-4214
(815) 363-3223
(815) 363-3240
Mailing address
7611 PERSHING BLVD, KENOSHA, WI 53142-4317
(262) 697-3668
(262) 697-3500
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
T059603
WI
Other
Enumeration date
01/21/2016
Last updated
01/21/2016
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