Shorewood Family Medical Clinic S.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SHOREWOOD FAMILY MEDICAL CLINIC S.C.

Practice address

4400 Sheridan Rd
Kenosha, WI 53140-5747

Phone

(262) 652-5454

Fax

(262) 652-5732

NPI assigned

Dec 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Timothy Michael Hubbard, D.O.NPI 1568523389

Title

President

Phone

(262) 652-5454

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy Michael Hubbard, D.O.

  • Family Medicine Physician
  • Kenosha, WI
  • NPI 1568523389
  Authorized official Same address or phone

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770644346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 SHERIDAN RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531405747",
            "telephone_number": "262-652-5454",
            "fax_number": "262-652-5732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 SHERIDAN RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531405747",
            "telephone_number": "262-652-5454",
            "fax_number": "262-652-5732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOREWOOD FAMILY MEDICAL CLINIC S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HUBBARD",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-652-5454",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Devinder K Sidhu, M.D.

• Family Medicine Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.