Organization
CHILDREN'S MEDICAL GROUP
Active
Parent organization
CHILDREN'S MEDICAL GROUP
Other names
MBH Telehealth
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S MEDICAL GROUP
Authorized official
DR. SMRITI KHARE M.D. (PRESIDENT)
(414) 266-6404
Entity
Organization
Contact information
Practice address
3365 S 103RD ST, MILWAUKEE, WI 53227-4161
(414) 228-4800
(262) 432-9004
Mailing address
9000 W WISCONSIN AVE # MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-6238
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205068616
—
WI
Enumeration date
08/18/2009
Last updated
02/17/2023
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