NPIMap

Organization Active NPI

Internal Medicine Clinic SC

  • Primary Care Clinic/Center
  • Oconomowoc, WI
National Provider Identifier
1245372994
Registry record updated Sep 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
21232 Issued in WI
Legal business name
INTERNAL MEDICINE CLINIC SC
Practice address
1229 Robruck Dr
Oconomowoc, WI 53066-4446
Phone
(262) 567-0227
Fax
(262) 567-0229
NPI assigned
Feb 12, 2007
Last updated
Sep 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dan Cleary
Title
President
Phone
(262) 567-0227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 21232 WI Primary

Addresses

Primary practice location

1229 Robruck Dr
Oconomowoc, WI 53066-4446

Mailing address

1229 Robruck Dr
Oconomowoc, WI 53066-4446
Phone (262) 567-0227

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1245372994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 ROBRUCK DR",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664446",
            "telephone_number": "262-567-0227",
            "fax_number": "262-567-0229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 ROBRUCK DR",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664446",
            "telephone_number": "262-567-0227",
            "fax_number": "262-567-0229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "CLEARY",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-567-0227",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WI",
            "license": "21232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconomowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.