Individual
KEVIN EDWARD WASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 THEDA CLARK MEDICAL PLZ, SUITE 400, NEENAH, WI 54956-2763
(920) 725-4527
(920) 725-0991
Mailing address
100 THEDA CLARK MEDICAL PLZ, SUITE 400, NEENAH, WI 54956-2763
(920) 725-4527
(920) 725-0991
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
37076
WI
2086S0127X
Trauma Surgery Physician
37076
WI
2086S0129X
Vascular Surgery Physician
37076
WI
208C00000X
Colon & Rectal Surgery Physician
37076
WI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
37076
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32162500
—
WI
Enumeration date
05/12/2006
Last updated
05/08/2008
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