Organization
MEA-AEA KENOSHA SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN HOLTZCLAW MD (PRESIDENT)
(440) 887-4718
Entity
Organization
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5640
(440) 842-8835
Mailing address
PO BOX 637562, MEA-AEA KENOSH SC, CINCINNATI, OH 45263-0001
(440) 887-4718
(440) 842-8835
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21262900
—
WI
Enumeration date
08/23/2005
Last updated
02/21/2012
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us