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Great Lakes Family Medical Center Inc

Clinic/Center in Kenosha, WI · enumerated 2007 · authorized official Jawaid Quddus, President.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1093900136

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Registry record

Entity type Organization (Type 2)
Legal business name Great Lakes Family Medical Center Inc
Practice address 6123 Green Bay Rd, Suite 120, Kenosha, WI, 53142
Phone (262) 764-4390
Fax (262) 764-4396
Enumeration date Sep 12, 2007
Last updated in NPPES Aug 26, 2010

Taxonomy & classification

261Q00000X Clinic/Center Ambulatory Health Care Facilities · License 45606020 (WI) Primary

Authorized official

Name Jawaid Quddus
Title President
Phone (262) 764-4390

Other identifiers

Identifier Type State Issuer
34414100 Medicaid WI -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is a Type 2 NPI?
A Type 2 NPI identifies an organization (group practice, hospital, pharmacy, lab), while Type 1 NPIs identify individual providers. Organizations bill under their Type 2 NPI.
What type of organization is Great Lakes Family Medical Center Inc?
Great Lakes Family Medical Center Inc is registered in NPPES as a Clinic/Center (its primary provider taxonomy).

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2010-08-26.