Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Cleanslate Medical Group of Wisconsin, SC

Organization Addiction Medicine (Internal Medicine) Physician · NPI 1518404854

Cleanslate Medical Group of Wisconsin, SC is an Addiction Medicine (Internal Medicine) Physician in Glendale, Wisconsin. Registered with an NPI since 2017.

In the registry since
2017

Practice location Address checks out

377 W River Woods Pkwy Ste 201
Glendale, WI 53212-1088
Phone: (413) 323-6880
Fax: (833) 279-7074
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction Medicine (Internal Medicine) Physician (primary) Taxonomy 207RA0401X

Record details

NPI number1518404854
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Matthew Smolarek — Cfo · (412) 999-5188
NPI enumeratedJanuary 25, 2017
Last updated in NPPESDecember 17, 2025
Certification dateDecember 17, 2025
Mailing address8 Cadillac Dr Ste 300, Brentwood, TN 37027-5337

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