Organization
FAMILY MEDICAL CLINIC, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JAMES KLUGE (MEDICAL STAFF ASSISTANT)
(920) 262-4784
Entity
Organization
Contact information
Practice address
1507 DOCTORS CT, WATERTOWN, WI 53094-4101
(920) 261-4111
Mailing address
PO BOX 110, WATERTOWN, WI 53094-0110
(920) 262-4784
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21266600
—
WI
Enumeration date
10/17/2006
Last updated
11/29/2007
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