Organization
PREMISE HEALTH OF CONNECTICUT MEDICAL, P.C.
Active
Other names
Harley Davidson Health Center- Pilgrim Road
Organization subpart
No
Provider details
NPI number
Authorized official
JON LEIZMAN M.D. (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
W156 N 9000 RILGRIM RD, MENOMONEE FALLS, WI 53051
(262) 502-8752
(262) 502-8756
Mailing address
16906 COLLECTION CENTER DR, CHICAGO, IL 60693-0169
(262) 502-8752
(262) 502-8756
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2011
Last updated
08/15/2022
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