Organization
CHILDREN'S MEDICAL GROUP
Active
Parent organization
CHILDREN'S MEDICAL GROUP
Other names
Lakeside Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S MEDICAL GROUP
Authorized official
SMRITI KHARE M.D. (PRESIDENT, CHILDREN'S MEDICAL GROUP)
(414) 266-7615
Entity
Organization
Contact information
Practice address
8600 75TH ST, SUITE 101, KENOSHA, WI 53142-8200
(262) 652-9430
(262) 652-9433
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
—
21260600
—
WI
Enumeration date
04/28/2008
Last updated
11/30/2011
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