Organization
CHILDREN'S MEDICAL GROUP
Active
Parent organization
CHILDREN'S MEDICAL GROUP
Other names
Kenosha Peds - Paddock Lake Site
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S MEDICAL GROUP
Authorized official
DR. SMRITI KHARE M.D. (PRESIDENT, CHILDREN'S MEDICAL GROUP)
(414) 266-7615
Entity
Organization
Contact information
Practice address
24906 75TH ST, SALEM, WI 53168-9705
(262) 843-2378
(262) 843-3053
Mailing address
9000 W WISCONSIN AVE, MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-1853
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32854500
—
WI
Enumeration date
04/28/2008
Last updated
11/30/2011
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