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

Green Lake Medical Clinic , SC

Organization Family Medicine Physician · NPI 1306986716

Green Lake Medical Clinic , SC is a Family Medicine Physician in Green Lake, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2007.

Licensed in
WI
In the registry since
2007

Practice location Address checks out

N6205 Busse Dr
Green Lake, WI 54941
Phone: (920) 294-3444
Fax: (920) 294-6660
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 17659 (WI)

Record details

NPI number1306986716
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Thomas Willett — President · (920) 294-3444
NPI enumeratedFebruary 7, 2007
Last updated in NPPESAugust 22, 2020
Mailing addressN6205 Busse Drive, Po Box 429, Green Lake, WI 54941

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