Individual
MATTHEW LEE VELISSARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4001 W CAPITOL DR, MILWAUKEE, WI 53216-2530
(414) 759-5193
Mailing address
4929 W FOND DU LAC AVE, M, MILWAUKEE, WI 53216-2324
(414) 871-6122
(414) 871-2552
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1942-226
WI
Other
Enumeration date
08/23/2013
Last updated
06/09/2014
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