| Edward T Stevens Md Sc | |
|
600 52nd Street Suite 240 Kenosha WI 53140-3423 | |
| (262) 656-0006 | |
| (262) 656-0005 |
| Full Name | Edward T Stevens Md Sc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 600 52nd Street, Kenosha, Wisconsin |
| Authorized Official Name and Position | Edward Terrance Stevens (PRESIDENT) |
| Authorized Official Contact | 2626560006 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward T Stevens Md Sc 600 52nd Street Suite 240 Kenosha WI 53140-3423 Ph: (262) 656-0006 | Edward T Stevens Md Sc 600 52nd Street Suite 240 Kenosha WI 53140-3423 Ph: (262) 656-0006 |
| NPI Number | 1962521716 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962521716 | NPI | - | NPPES |
| 30305400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 22919020 (Wisconsin) | Primary |
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