| Organization Name: | SPECTRUM HEALTH MEDICAL CLINIC, LLC |
| NPI Number: | 1477981942 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH ALAN LOCKE (PRESIDENT/OWNER) |
| Mailing Address: | W176n9830 Rivercrest Dr Suite 102 Germantown |
| State: | WI US |
| Postal Code: | 530224625 |
| Phone Number: | 4143240944 |
| Fax Number: | 4149215600 |
| NPI Enumeration Date: | 10/21/2013 |
| NPI Last Update Date: | 03/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 53594 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |