Individual
EVA K ALESSIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3807 SPRING ST, MOUNT PLEASANT, WI 53405
(262) 687-8282
Mailing address
3807 SPRING ST, MOUNT PLEASANT, WI 53405-1667
(262) 687-8282
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036-098135
IL
208000000X
Pediatrics Physician
Primary
69561
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01932011
BLUE CROSS BLUE SHIELD
—
05
—
036098135
—
IL
01
—
50010723
TAT
—
Enumeration date
08/25/2005
Last updated
02/05/2021
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