Great Lakes Family Medical Center Inc
NPI 1093900136ActiveOrganization· Clinic/Center· Kenosha, WI
Clinic/Center in Kenosha, Wisconsin, registered in NPPES in September 2007. The authorized official on file is Jawaid Quddus, M.D., PH.D., President.
Overview
| NPI | 1093900136 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 12, 2007 |
| Last updated in NPPES | Aug 26, 2010 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Clinic/Center Primary | 261Q00000X | 45606020 | WI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Clinic/Center providers in Kenosha
- 1144638065
- 1336008408
- 1619811841
- 1699079079
- 1750225983
- 1992649123