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

Great Lakes Family Medical Center Inc

Organization Clinic/Center · NPI 1093900136

Great Lakes Family Medical Center Inc is a Clinic/Center in Kenosha, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2007.

Licensed in
WI
In the registry since
2007
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

6123 Green Bay Rd Ste 120
Kenosha, WI 53142-2927
Phone: (262) 764-4390
Fax: (262) 764-4396
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinic/Center (primary) Taxonomy 261Q00000X · Licence 45606020 (WI)

Record details

NPI number1093900136
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jawaid Quddus — President · (262) 764-4390
NPI enumeratedSeptember 12, 2007
Last updated in NPPESAugust 26, 2010
Mailing address6123 Green Bay Road, Suite 120, Kenosha, WI 53142-2927

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