Organization
EDWARD T STEVENS MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD TERRANCE STEVENS MD (PRESIDENT)
(262) 656-0006
Entity
Organization
Contact information
Practice address
600 52ND STREET, SUITE 240, KENOSHA, WI 53140-3423
(262) 656-0006
(262) 656-0005
Mailing address
600 52ND STREET, SUITE 240, KENOSHA, WI 53140-3423
(262) 656-0006
(262) 656-0005
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
22919020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30305400
—
WI
Enumeration date
03/29/2007
Last updated
08/22/2020
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