Organization
KENOSHA UROLOGY CLINIC, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NED R. NOVSAM M.D. (VICE-PRESIDENT)
(262) 656-8213
Entity
Organization
Contact information
Practice address
6308 8TH AVE, SUITE 503, KENOSHA, WI 53143-5031
(262) 656-8213
(262) 656-8233
Mailing address
6308 8TH AVE, SUITE 503, KENOSHA, WI 53143-5031
(262) 656-8213
(262) 656-8233
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
308295
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32729100
—
WI
Enumeration date
10/05/2006
Last updated
06/03/2008
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