Organization
WEST BEND CLINIC, INC.
Active
Other names
West Bend Clinic South
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY G BLOMMEL (MEDICAL DIRECTOR)
(262) 334-3451
Entity
Organization
Contact information
Practice address
3200 PLEASANT VALLEY RD, WEST BEND, WI 53095-9274
(262) 334-3451
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VM0101X
Maternal & Fetal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21251400
—
WI
Enumeration date
08/08/2006
Last updated
05/23/2012
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