Individual
ALEC SAMUEL SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Mailing address
808 S WOOD ST RM 469A, CHICAGO, IL 60612-7300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036.166609
IL
207P00000X
Emergency Medicine Physician
Primary
81508-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100278001
—
WI
Enumeration date
04/01/2021
Last updated
09/17/2024
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