West Bend Clinic

NPI #1275542607 in Jackson, Wisconsin

Provider Information

NPI Number: 1275542607
Entity Type: Organization
Organization Name: West Bend Clinic
Primary Specialty: Family Medicine
Enumeration Date: Aug 5, 2006
Last Updated: May 23, 2012

Practice Location

Address: W225N16711 CEDAR PARK CT
City: Jackson
State: Wisconsin
ZIP Code: 53037-9222
Phone: (262) 677-1101

Authorized Official

Name: GREGORY G BLOMMEL
Title: MEDICAL DIRECTOR
Phone: (262) 334-3451

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies	332B00000X
Family Medicine	207Q00000X	Primary

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