Organization
SPECTRUM HEALTH MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH ALAN LOCKE DO (PRESIDENT/OWNER)
(414) 324-0944
Entity
Organization
Contact information
Practice address
W176N9830 RIVERCREST DR, SUITE 102, GERMANTOWN, WI 53022-4625
(414) 324-0944
(414) 921-5600
Mailing address
PO BOX 639, THIENSVILLE, WI 53092-0639
(414) 247-9005
(414) 247-9004
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
53594
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902078801
NPI INDIVIDUAL
—
01
—
K100107570
MEDICARE PTAN
WI
01
—
K400107593
MEDICARE PTAN INDIVIDUAL
—
Enumeration date
10/21/2013
Last updated
03/13/2014
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