Organization
FAMILY MEDICINE & SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEIL JAMES RENNICK D.O. (SOLE PROPRIETOR)
(262) 642-7313
Entity
Organization
Contact information
Practice address
3066 MAIN ST, EAST TROY, WI 53120-1148
(262) 642-7313
(262) 642-4251
Mailing address
3066 MAIN ST, EAST TROY, WI 53120-1148
(262) 642-7313
(262) 642-4251
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
26462
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508062043
TYPE 1 NPI
WI
01
—
26462
STATE OF WISCONSIN LICENSE
WI
05
—
30100300
—
WI
01
—
80591
MEDICARE ID
WI
Enumeration date
02/24/2011
Last updated
02/24/2011
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