Organization
IHC-SNF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY A CIERLIK (PRESIDENT - COO)
(414) 290-6700
Entity
Organization
Contact information
Practice address
8633 32ND AVE, KENOSHA, WI 53142-5187
(414) 290-6720
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
09/22/2016
Last updated
09/22/2016
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