Provider Demographics
NPI:1619943354
Name:MICELI, GIUSEPPE S (DPM)
Entity Type:Individual
Prefix:DR
First Name:GIUSEPPE
Middle Name:S
Last Name:MICELI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201-GREEN BAY ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142
Mailing Address - Country:US
Mailing Address - Phone:262-925-6565
Mailing Address - Fax:262-697-4291
Practice Address - Street 1:7201 GREEN BAY RD
Practice Address - Street 2:SUITE A
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-3532
Practice Address - Country:US
Practice Address - Phone:262-925-6565
Practice Address - Fax:262-697-4291
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI524-025213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43208700Medicaid
WI000182409Medicare PIN
WI5881250001Medicare NSC
WI43208700Medicaid