OrganizationActive
Great Lakes Surgery LLC
NPI 1629518006 · Ambulatory Surgical Clinic/Center · Kenosha, WI
Provider details
- NPI number
- 1629518006
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- John Bostanche, Director(262) 657-0224
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
6123 Green Bay Rd Ste 101
Kenosha, WI 53142-2927
Phone: (262) 657-0224
Approximate (ZIP-level) locationGet directions
Mailing address
6123 Green Bay Rd
Kenosha, WI 53142-2927
Registry dates
- Enumerated
- 2017-03-03
- Last updated
- 2017-03-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.