Individual
MR. BRENT T VISSAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
(262) 948-5735
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(262) 948-5600
(262) 948-5735
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2576-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100011215
—
WI
Enumeration date
07/08/2010
Last updated
12/29/2021
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