Organization
GREAT MIDWEST MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT DONALD MATTEUCCI D.P.M. (PRESIDENT)
(262) 945-1094
Entity
Organization
Contact information
Practice address
17495 W CAPITOL DR, UNIT K, BROOKFIELD, WI 53045-2059
(262) 945-1094
Mailing address
17495 W CAPITOL DR, UNIT K, BROOKFIELD, WI 53045-2059
(262) 945-1094
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
07/27/2011
Last updated
12/07/2011
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