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Organization
FAITHFUL PHYSICIAN SERVICES LLC
Active
Organization
FAITHFUL PHYSICIAN SERVICES LLC
Active
Other names
Faithful Physician Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN MATHER KOTSONIS M.D. (OWNER)
(262) 373-6733
Entity
Organization
Contact information
Practice address
1109 CECELIA DRIVE, PEWAUKEE, WI 53072-2524
(262) 373-6733
(262) 373-6018
Mailing address
12420 W HAMPTON AVE #89, BUTLER, WI 53007-0089
(262) 373-6733
(262) 373-6018
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
53437-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100031662
—
WI
Enumeration date
12/20/2015
Last updated
06/27/2018
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