Individual
SAMUAL DEAN KOTSONAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 ALFORD DR, KENOSHA, WI 53140-1927
(952) 300-7222
Mailing address
14521 GENESEE AVE, APPLE VALLEY, MN 55124-8420
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
WI
Other
Enumeration date
02/08/2021
Last updated
02/08/2021
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