Individual
STEPHEN M. KORDIYAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
115 E 5TH AVE, ANTIGO, WI 54409-2711
(715) 623-2331
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4257
(262) 787-4026
(262) 782-6040
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
113499
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
044383
CRNA RECERTIFICATION CARD
—
05
—
43314500
—
WI
Enumeration date
01/27/2006
Last updated
04/02/2010
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