Organization
PROVIDENCE FAMILY MEDICAL CLINIC S.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADEDAPO F OKUSANYA M.D. (PRESIDENT)
(269) 598-7404
Entity
Organization
Contact information
Practice address
2500 W SILVER SPRING DR, GLENDALE, WI 53209-4218
(414) 800-7171
(414) 800-7166
Mailing address
2500 W SILVER SPRING DR, GLENDALE, WI 53209-4218
(414) 800-7171
(414) 800-7166
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/22/2015
Last updated
12/22/2015
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