Organization
WILDWOOD FAMILY CLINIC, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERYL GREEN (ADMINISTRATOR)
(608) 221-1501
Entity
Organization
Contact information
Practice address
535 SOUTHING GRANGE, COTTAGE GROVE, WI 53527-9338
(608) 839-3515
(608) 839-3541
Mailing address
535 SOUTHING GRANGE, COTTAGE GROVE, WI 53527-9338
(608) 839-3515
(608) 839-3541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32721000
—
WI
Enumeration date
11/01/2006
Last updated
08/22/2020
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