Organization
SHOREWOOD FAMILY MEDICAL CLINIC S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MICHAEL HUBBARD D.O. (PRESIDENT)
(262) 652-5454
Entity
Organization
Contact information
Practice address
4400 SHERIDAN RD, KENOSHA, WI 53140-5747
(262) 652-5454
(262) 652-5732
Mailing address
4400 SHERIDAN RD, KENOSHA, WI 53140-5747
(262) 652-5454
(262) 652-5732
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
12/13/2006
Last updated
08/22/2020
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