| Family Medicine & Surgery Llc | |
|
3066 Main St East Troy WI 53120-1148 | |
| (262) 642-7313 | |
| (262) 642-4251 |
| Full Name | Family Medicine & Surgery Llc |
|---|---|
| Speciality | General Practice |
| Location | 3066 Main St, East Troy, Wisconsin |
| Authorized Official Name and Position | Neil James Rennick (SOLE PROPRIETOR) |
| Authorized Official Contact | 2626427313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine & Surgery Llc 3066 Main St East Troy WI 53120-1148 Ph: (262) 642-7313 | Family Medicine & Surgery Llc 3066 Main St East Troy WI 53120-1148 Ph: (262) 642-7313 |
| NPI Number | 1922305077 |
|---|---|
| Provider Enumeration Date | 02/24/2011 |
| Last Update Date | 02/24/2011 |
| Medicare PECOS PAC ID | 0042491862 |
|---|---|
| Medicare Enrollment ID | O20110225000578 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922305077 | NPI | - | NPPES |
| 1508062043 | Other | WI | TYPE 1 NPI |
| 30100300 | Medicaid | WI | |
| 26462 | Other | WI | STATE OF WISCONSIN LICENSE |
| 80591 | Other | WI | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 26462 (Wisconsin) | Primary |
| Provider Name | Neil James Rennick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508062043 PECOS PAC ID: 7012199227 Enrollment ID: I20110309000682 |