| 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 |
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