Faithful Physician Services | |
1109 Cecelia Drive Pewaukee WI 53072-2524 | |
(262) 373-6733 | |
(262) 373-6018 |
Full Name | Faithful Physician Services |
---|---|
Speciality | Family Medicine |
Location | 1109 Cecelia Drive, Pewaukee, Wisconsin |
Authorized Official Name and Position | Steven Mather Kotsonis (OWNER) |
Authorized Official Contact | 2623736733 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Faithful Physician Services 12420 W Hampton Ave #89 Butler WI 53007-0089 Ph: (262) 373-6733 | Faithful Physician Services 1109 Cecelia Drive Pewaukee WI 53072-2524 Ph: (262) 373-6733 |
NPI Number | 1467817320 |
---|---|
Provider Enumeration Date | 12/20/2015 |
Last Update Date | 06/27/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467817320 | NPI | - | NPPES |
100031662 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 53437-20 (Wisconsin) | Primary |
News Archive
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