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

Community Medical Center of Green Lake, LLC

Organization Family Medicine Physician · NPI 1568622280

Community Medical Center of Green Lake, LLC is a Family Medicine Physician in Green Lake, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2008.

Licensed in
WI
In the registry since
2008
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

670 County Road A
Green Lake, WI 54941
Phone: (920) 294-0100
Fax: (920) 294-0123
Show map & directions

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

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 44378 (WI)

Record details

NPI number1568622280
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Thomas Krystowiak — Chief Financial Officer · (920) 361-1313
Other names Chn Medical Center Green Lake
NPI enumeratedJune 16, 2008
Last updated in NPPESMay 2, 2014
Mailing address670 County Road A, Green Lake, WI 54941

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