Organization
GREAT LAKES MEDICAL & SURGICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BAHRAM NAMDARI MD (OWNER)
(414) 282-7575
Entity
Organization
Contact information
Practice address
6000 SOUTH 27TH STREET, MILWAUKEE, WI 53221
(414) 282-7575
Mailing address
PO BOX 210464, MILWAUKEE, WI 53221
(414) 282-7575
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
19858020
WI
2086S0129X
Vascular Surgery Physician
19858020
WI
Other
Enumeration date
07/17/2007
Last updated
07/17/2007
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