Organization
SENIORWELL OF WISCONSIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH KING (OWNER)
(844) 882-3127
Entity
Organization
Contact information
Practice address
11414 W PARK PL STE 202, MILWAUKEE, WI 53224-3500
(844) 882-3127
Mailing address
2100 E LAKE COOK RD STE 1000, BUFFALO GROVE, IL 60089-1999
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
152W00000X
Optometrist
—
—
231H00000X
Audiologist
—
—
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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