Mea-Aea Kenosha Sc
Emergency Medicine in Kenosha, WI. Organization (NPI-2).
NPI number1477546737
StatusActive
Last updated in NPPESFeb 21, 2012
Details
- NPI
- 1477546737
- Entity type
- Organization (NPI-2)
- Legal business name
- Mea-Aea Kenosha Sc
- Organization subpart
- No
- Enumeration date
- Aug 23, 2005
- Last updated
- Feb 21, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207P00000X | Emergency Medicine | – | – | Yes |
| 207Q00000X | Family Medicine | – | – |
Practice location
10400 75th StKenosha, WI 53142-7884
Phone 262-948-5640 · Fax 440-842-8835
Mailing address
Po Box 637562Mea-Aea Kenosh Sc
Cincinnati, OH 45263-0001
Phone 440-887-4718 · Fax 440-842-8835
Authorized official
Stephen Holtzclaw
President
4408874718
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