Childrens Medical Group Inc
Organization Active NPI Pediatrics Physician · Milwaukee, WI
NPI 1790732410 · NPPES record last updated May 21, 2025
Key facts
- NPI
- 1790732410
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- CHILDRENS MEDICAL GROUP INC
- Practice address
- 9000 W Wisconsin Ave
Ms 958
Milwaukee, WI 53226-3518 - Phone
- (414) 266-7615
- Fax
- (414) 266-6238
- NPI assigned
- May 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Michael Gutzeit, MD
- Title
- President
- Phone
- (414) 266-3002
Corporate family (same tax ID) 37
Practitioners 18
-
Kelly S Campbell, ANP-BC
-
Kristin Anne Haglund, PHD, APRN
-
Roxanne J Kane, M.D.
-
William C Leach, M.D.
-
Tia C Medley, NP
-
David E Melbye, M.D.
-
Sadoun I Omari, M.D.
-
Sharyl Paley, M.D.
-
Karen M Wegner, M.D.
-
Barbara B Calkins, M.D.
-
Steven J Jereb, M.D.
-
William D Jeruc, M.D.
-
Mari L Lamers, M.D,
-
Andrew Campbell Leslie, M.D.
-
Matthew Nersesian, M.D.
-
Sara J Siedenburg, CPNP
-
Bradley W Kirschner, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031204000573 | WI | Part B Supplier - Clinic/Group Practice | 4981509742 |
Receives reassigned benefits from 10 practitioners Practice locations: Milwaukee, WI; New Berlin, WI; Oak Creek, WI; Salem, WI; Wauwatosa, WI; Brookfield, WI; Brown Deer, WI; Glendale, WI… |
National Provider Directory
- Tax ID family
- Childrens Medical Group Inc
Locations
6791 N Green Bay Ave
Glendale, WI 53209
Phone (414) 840-2551
6213 10th Ave
Kenosha, WI 53143
Phone (262) 654-8633
6308 8th Ave
#S3070
Kenosha, WI 53143
Phone (262) 652-9430
6125 Green Bay Rd
Ste 700
Kenosha, WI 53142
Phone (262) 654-0487
10046 N Port Washington Rd
Mequon, WI 53092
Phone (262) 240-9744
5757 W Oklahoma Ave
#S105
Milwaukee, WI 53219
Phone (414) 321-3951
2350 W Villard Ave
#S302
Milwaukee, WI 53209
Phone (414) 466-9530
3975 N 68th St
#S201
Milwaukee, WI 53216
Phone (414) 536-0236
3239 N 9th St
Milwaukee, WI 53206
Phone (414) 264-0465
2320 W Burleigh St
Milwaukee, WI 53206
Phone (414) 363-1200
2025 W Oklahoma Ave
#S105
Milwaukee, WI 53215
Phone (414) 385-9638
8661 S Howell Ave
Oak Creek, WI 53154
Phone (414) 764-5726
24906 75th St
Salem, WI 53168
Phone (262) 654-8633
2500 N Mayfair Rd
#S550
Wauwatosa, WI 53226
Phone (414) 479-9990
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | |||
| Clinical Social Worker |
1041C0700X | |||
| Dentist |
122300000X | |||
| Pediatrics Physician |
208000000X | Yes | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X |
Addresses
Primary practice location
9000 W Wisconsin Ave
Ms 958
Milwaukee, WI 53226-3518
Mailing address
9000 W Wisconsin Ave
Ms 958
Milwaukee, WI 53226-3518
Phone (414) 266-7615
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790732410 | Medicaid | WI |
Other providers in Milwaukee, WI
- Children'S Service Society of Wisconsin
- Children'S Service Society of Wisconsin
- Children'S Specialty Group, Inc.
- Childrens Hospital of Wisconsin Inc
- Childrens Hospital of Wisconsin, Inc.
- Childrens Physician Group PC
- Childrens Society of Wisconsin
- Keona Childs
- Loveline Ndikum Chimafor
- Ijeoma Ezioma Chimezie
All providers in Milwaukee, WI · Pediatrics Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.