West Bend Clinic

NPI #1518976919 in Kewaskum, Wisconsin

Provider Information

NPI Number: 1518976919
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: 1701 FOND DU LAC AVE
City: Kewaskum
State: Wisconsin
ZIP Code: 53040-9129
Phone: (262) 626-4616

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X
Pediatrics	208000000X
Radiology - Body Imaging — Body Imaging	2085B0100X
Durable Medical Equipment & Medical Supplies	332B00000X
Family Medicine	207Q00000X	Primary

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