MEA-AEA KENOSHA SC (NPI# 1477546737) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477546737 |
| Entity Type | Organization |
| Organization Name | MEA-AEA KENOSHA SC |
| Practice Address |
10400 75th St Kenosha WI 53142-7884 |
| Mailing Address |
Po Box 637562 Mea-aea Kenosh Sc Cincinnati OH 45263-0001 |
| Practice Telephone | 2629485640 |
| Practice Fax Number | 4408428835 |
| Mailing Telephone | 4408874718 |
| Mailing Fax Number | 4408428835 |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2012-02-21 |
| Authorized Official Name | STEPHEN HOLTZCLAW (PRESIDENT) |
| Authorized Official Telephone | 4408874718 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21262900 | 05 |
| Street Address |
10400 75TH ST |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-7884 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548877707 | Megan Labine | Dietitian, Registered | 10400 75th St, Kenosha, WI 53142-7884 | 2020-09-30 |
| 1730796574 | Saralyn Paredes | Nurse Practitioner | 10400 75th St, Kenosha, WI 53142-7884 | 2020-09-25 |
| 1518586965 | Ariel Adelsen | Registered Nurse | 10400 75th St, Kenosha, WI 53142-7884 | 2020-04-15 |
| 1134757073 | Amber Jirschele | Nurse Practitioner | 10400 75th St, Kenosha, WI 53142-8323 | 2020-03-27 |
| 1912539974 | Kristina A Roscizewski | Nurse Practitioner | 10400 75th St, Kenosha, WI 53142-7884 | 2020-02-07 |
| 1386274413 | Ethan Nathaniel Mcfaddin | Pharmacist | 10400 75th St, Kenosha, WI 53142-7884 | 2020-01-16 |
| 1972133031 | Patricia Grzyb | Physician Assistant | 10400 75th St, Kenosha, WI 53142-7884 | 2020-01-16 |
| 1144873654 | Lauren Cornejo | Occupational Therapist | 10400 75th St, Kenosha, WI 53142-8323 | 2019-07-23 |
| 1245710771 | Brenda Joyce Woodhull | Registered Nurse | 10400 75th St, Kenosha, WI 53142-7884 | 2018-08-15 |
| 1851877633 | Sara Ann Muench | Dietitian, Registered | 10400 75th St, Kenosha, WI 53142-7884 | 2018-07-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336251859 | Stephen P Lang | Emergency Medicine | 9314 74th Pl, Kenosha, WI 53142-7659 | 2006-08-31 |
| 1225478993 | Lauren M Towle | Emergency Medicine | 10400 75th St, Kenosha, WI 53142-7884 | 2013-06-26 |
| 1952536104 | Ryan Nicholas Chellin | Emergency Medicine | 10400 75th St, Kenosha, WI 53142-7884 | 2009-05-18 |
| 1477792406 | Stephen Henry Laskiewicz | Emergency Medicine | 10400 75th St, Kenosha, WI 53142-7884 | 2009-02-15 |
| 1205003142 | Benjamin A Feinzimer | Emergency Medicine | 6308 8th Ave, Kenosha, WI 53143-5031 | 2008-05-09 |
| 1497785463 | John D Pettinger | Emergency Medicine | 10400 75th St, Kenosha, WI 53142-7884 | 2006-07-04 |
| 1083666796 | Kimberly Roberson | Emergency Medicine | 10400 75th St, Kenosha, WI 53142-7884 | 2006-05-17 |
| 1942266549 | Kelly Anthony Robinson | Emergency Medicine | 10400 75th St, Aurora Medical Center, Kenosha, WI 53142 | 2006-04-22 |
| 1770560278 | William T Kumprey | Emergency Medicine | 10400 75th St, Aurora Medical Center Emergency Department, Kenosha, WI 53142-7884 | 2005-12-27 |
| 1225015704 | Therese Marie Whitt | Emergency Medicine | 10400 75th St, Aurora Medical Center, Kenosha, WI 53142 | 2005-12-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.