Individual
MR. WILLIAM T WHALEN IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.O.
Contact information
Practice address
5027 GREEN BAY RD, SUITE 124, KENOSHA, WI 53144-1771
(262) 654-4300
(262) 654-4305
Mailing address
5027 GREEN BAY RD, SUITE 124, KENOSHA, WI 53144-1771
(262) 654-4300
(262) 654-4305
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
213000315
IL
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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