Young, Gregory W

Young, Gregory W is an individual health care provider with primary practice located at 6809 122Nd Ave , Kenosha WI 53142-7335. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Young, Gregory W can be contacted via phone (262) 654-8633.

Contact Information

Primary practice address
6809 122Nd Ave Kenosha WI 53142-7335
Fax: (262) 654-5467
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 20264 Wisconsin

Profile Details

NPI number 1194710129
LBN Legal business name Young, Gregory W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 15th, 2005
Last updated Feb 13th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1194710129 NPPES
Wisconsin MEDICAID 30211300

Popular Providers