Organization
COMMUNITY MEDICAL CENTER OF GREEN LAKE, LLC
Active
Other names
CHN Medical Center Green Lake
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS KRYSTOWIAK (CHIEF FINANCIAL OFFICER)
(920) 361-1313
Entity
Organization
Contact information
Practice address
670 COUNTY ROAD A, GREEN LAKE, WI 54941
(920) 294-0100
(920) 294-0123
Mailing address
670 COUNTY ROAD A, GREEN LAKE, WI 54941
(920) 294-0100
(920) 294-0123
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44378
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21329400
—
WI
Enumeration date
06/16/2008
Last updated
05/02/2014
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