Organization
PROACTIVE MD WI SC
Active
Other names
Proactive MD Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JODY ADDAIR (CLINICAL OPS PROJECT COORDINATOR)
(317) 556-0017
Entity
Organization
Contact information
Practice address
20611 WATERTOWN RD STE C, WAUKESHA, WI 53186-1871
(864) 501-0751
Mailing address
124 ALLAWOOD CT, SIMPSONVILLE, SC 29681-6207
(864) 501-0751
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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