Provider Demographics
NPI:1578611703
Name:ANITA I. INVEISS, M.D., S.C.
Entity Type:Organization
Organization Name:ANITA I. INVEISS, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:ILZE
Authorized Official - Last Name:INVEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-654-0765
Mailing Address - Street 1:3618 8TH AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-2576
Mailing Address - Country:US
Mailing Address - Phone:262-654-0260
Mailing Address - Fax:262-654-8577
Practice Address - Street 1:3618 8TH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-2576
Practice Address - Country:US
Practice Address - Phone:262-654-0260
Practice Address - Fax:262-654-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31740600Medicaid
WI31740600Medicaid
E86644Medicare UPIN