Individual
SONYA MARIE VIDEKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPAS
Contact information
Practice address
2000 E LAYTON AVE, ST FRANCIS, WI 53235-6053
(414) 744-7880
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 744-7880
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4138
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071914
—
WI
Enumeration date
08/14/2017
Last updated
10/17/2023
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