OrganizationActive
Great Lakes Family Medical Center Inc
NPI 1093900136 · Clinic/Center · Kenosha, WI
Great Lakes Family Medical Center Inc is a Clinic/Center organization in Kenosha, WI (NPI 1093900136).
Provider details
- NPI number
- 1093900136
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Jawaid Quddus, President(262) 764-4390
- License
- 45606020 (WI)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(88/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
6123 Green Bay Rd
Suite 120
Kenosha, WI 53142-2927
Phone: (262) 764-4390
Fax: (262) 764-4396
Street-level locationGet directions
Mailing address
6123 Green Bay Road
Kenosha, WI 53142-2927
Registry dates
- Enumerated
- 2007-09-12
- Last updated
- 2010-08-26
Frequently asked questions
- What is Great Lakes Family Medical Center Inc's NPI number?
- Great Lakes Family Medical Center Inc's National Provider Identifier (NPI) is 1093900136, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Great Lakes Family Medical Center Inc?
- Great Lakes Family Medical Center Inc is classified in the NPPES registry as Clinic/Center (Ambulatory Health Care Facilities).
- Where is Great Lakes Family Medical Center Inc located?
- Great Lakes Family Medical Center Inc's practice location on file with NPPES is 6123 Green Bay Rd, Kenosha, WI 53142-2927.
- What is Great Lakes Family Medical Center Inc's phone number?
- The practice phone number listed in the NPPES registry for Great Lakes Family Medical Center Inc is (262) 764-4390.
- Who is the authorized official for Great Lakes Family Medical Center Inc?
- The authorized official listed on Great Lakes Family Medical Center Inc's NPPES record is Jawaid Quddus, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Great Lakes Family Medical Center Inc's NPI active?
- Yes — Great Lakes Family Medical Center Inc's NPI (1093900136) is active in the NPPES registry as of the last update on 2010-08-26.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.