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Organization

CHILDREN'S MEDICAL GROUP

Active
Parent organization
CHILDREN'S MEDICAL GROUP
Other names
Jackson 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
N168W22730 PRAIRIE VIEW LANE, JACKSON, WI 53037
(262) 423-4800
(262) 423-4899
Mailing address
9000 W WISCONSIN AVE, MAIL STATION 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-6238

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1467996991
WI
Enumeration date
12/19/2016
Last updated
12/22/2016
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