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

Great Lakes Surgery LLC

Organization Ambulatory Surgical Clinic/Center · NPI 1629518006

Great Lakes Surgery LLC is an Ambulatory Surgical Clinic/Center in Kenosha, Wisconsin. Registered with an NPI since 2017.

In the registry since
2017
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

6123 Green Bay Rd Ste 101
Kenosha, WI 53142-2927
Phone: (262) 657-0224
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Ambulatory Surgical Clinic/Center (primary) Taxonomy 261QA1903X

Record details

NPI number1629518006
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Bostanche — Director · (262) 657-0224
NPI enumeratedMarch 3, 2017
Last updated in NPPESMarch 3, 2017
Mailing address6123 Green Bay Rd, Suite 100, Kenosha, WI 53142-2927

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