Organization
SHEBOYGAN MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VISHAL LAL (EXECUTIVE ADMINISTRATOR)
(414) 325-7246
Entity
Organization
Contact information
Practice address
2124 KOHLER MEMORIAL DR, STE 100, SHEBOYGAN, WI 53081
(920) 452-7246
(920) 452-7388
Mailing address
4131 W LOOMIS RD, STE 800, GREENFIELD, WI 53221
(414) 325-7246
(414) 325-3770
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41914800
—
WI
Enumeration date
06/17/2006
Last updated
10/24/2016
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