Organization
KENOSHA FAMILY PRACTICE, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN P FEUERBACH MD (PRESIDENT)
(262) 652-0500
Entity
Organization
Contact information
Practice address
5923 GREEN BAY RD, KENOSHA, WI 53144-3737
(262) 652-0500
(262) 652-1928
Mailing address
5923 GREEN BAY RD, KENOSHA, WI 53144-3737
(262) 652-0500
(262) 652-1928
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
30201
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21270500
—
WI
01
—
DA2461
RAILROAD MEDICARE
—
Enumeration date
11/28/2006
Last updated
02/20/2014
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