OrganizationActive
Great Lakes Surgery Center LLC
NPI 1700045168 · Ambulatory Surgical Clinic/Center · Kenosha, WI
Provider details
- NPI number
- 1700045168
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Lisa Thiery, Manager(262) 657-3668
- License
- PENDING (WI)
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
6123 Green Bay Rd
Suite 100
Kenosha, WI 53142-2927
Phone: (262) 657-3668
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 580772
Pleasant Prairie, WI 53158-8101
Registry dates
- Enumerated
- 2008-06-02
- Last updated
- 2011-03-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.