Individual
KEVIN ALAN SVOBODA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1333 COLLEGE AVE, SUITE B, SOUTH MILWAUKEE, WI 53172-1150
(414) 571-9146
(414) 571-9147
Mailing address
625 ENTERPRISE DR, OAK BROOK, IL 60523-8813
(630) 575-1980
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070012949
IL
225100000X
Physical Therapist
Primary
6069-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518923754
—
WI
01
—
859400081
MEDICARE
WI
01
—
P01161193
RAILROAD MEDICARE
WI
01
—
WI2660002
MEDICARE
WI
Enumeration date
04/25/2006
Last updated
04/21/2016
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