Organization
CHILDREN'S MEDICAL GRUOP
Active
Parent organization
CHILDREN'S MEDICAL GROUP
Other names
Greensqure Developmental Specialists
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
6791 N GREEN BAY AVE, GLENDALE, WI 53209-3422
(414) 228-4800
(414) 228-0894
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
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21305800
—
WI
Enumeration date
04/28/2008
Last updated
01/19/2012
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