Organization Name: | FAMILY MEDICINE & SURGERY LLC |
NPI Number: | 1922305077 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NEIL JAMES RENNICK (SOLE PROPRIETOR) |
Mailing Address: | 3066 Main St East Troy |
State: | WI US |
Postal Code: | 531201148 |
Phone Number: | 2626427313 |
Fax Number: | 2626424251 |
NPI Enumeration Date: | 02/24/2011 |
NPI Last Update Date: | 02/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 26462 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |