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Organization

WEST BEND CLINIC, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GREGORY G BLOMMEL MD (MEDICAL DIRECTOR)
(262) 306-6336
Entity
Organization

Contact information

Practice address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
207Q00000X
Family Medicine Physician
Primary
207R00000X
Internal Medicine Physician
207V00000X
Obstetrics & Gynecology Physician
207W00000X
Ophthalmology Physician
207X00000X
Orthopaedic Surgery Physician
207Y00000X
Otolaryngology Physician
208000000X
Pediatrics Physician
2084N0400X
Neurology Physician
2085R0202X
Diagnostic Radiology Physician
2085U0001X
Diagnostic Ultrasound Physician
208600000X
Surgery Physician
208800000X
Urology Physician
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
21251400
WI
Enumeration date
03/07/2006
Last updated
05/04/2011
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