Individual
MITCHELL EDWARD MLEZIVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 243-4414
Mailing address
509 HILLCREST CT, SAUKVILLE, WI 53080-2560
(920) 536-0647
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1720-39
WI
Other
Enumeration date
05/07/2018
Last updated
05/07/2018
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