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Contact Information

CHILDREN'S MEDICAL GROUP
611 VETERANS AVE STE 106
WEST BEND, WI53090-2545
 Phone: 262-353-4460
 Fax: 262-353-4461
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Child & Adolescent Psychiatry

2084P0804X 86 Physician/Neuropsychiatry
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Clinical Child & Adolescent

103TC2200X 62 Psychologist, Clinical
 

Marriage & Family Therapist

106H00000X
 

Mental Health

101YM0800X
 

Professional

101YP2500X
 

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Social Worker

104100000X
Indicates primary specialty

NPI Profile & details for CHILDREN'S MEDICAL GROUP

NPI Number 1992171987
LBN Legal business name CHILDREN'S MEDICAL GROUP
Authorized official SMRITI KHARE - (PRESIDENT-CHILDREN'S MEDICAL GROUP)
Entity Organization
Organization subpart 1 Yes
Enumeration date 08/13/2015
Last updated 09/27/2021 - About 5 years ago
Identifiers
WI Medicaid 1992171987
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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