Organization
CHILDREN'S MEDICAL GROUP
Active
Parent organization
CHILDREN'S MEDICAL GROUP
Other names
North Shore Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S MEDICAL GROUP
Authorized official
DR. SMRITI KHARE MD (PRESIDENT, CHILDREN'S MEDICAL GROUP)
(414) 266-7615
Entity
Organization
Contact information
Practice address
1655 W. MEQUON ROAD, MEQUON, WI 53092-3230
(262) 240-9744
(262) 240-9745
Mailing address
9000 W WISCONSIN AVE, MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-1853
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
208000000X
Pediatrics Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801061064
—
WI
Enumeration date
04/28/2008
Last updated
09/24/2021
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