Individual
BART L MENGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1715 60TH STREET, KENOSHA, WI 53140
(262) 496-1333
(262) 657-0244
Mailing address
1715 60TH STREET, KENOSHA, WI 53140
(262) 496-1333
(262) 657-0244
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1185780
WI
Other
Enumeration date
05/30/2018
Last updated
05/30/2018
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