Organization
KENOSHA SURGICENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSEL LEIN JD (CHIEF EXECUTIVE OFFICER)
(414) 531-4327
Entity
Organization
Contact information
Practice address
10105 74TH ST STE 102, KENOSHA, WI 53142-7530
(262) 297-7246
Mailing address
2500 W LAYTON AVE STE 120, MILWAUKEE, WI 53221-5400
(262) 297-7246
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
06/01/2022
Last updated
06/08/2022
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