Provider Demographics
NPI:1750504346
Name:V. STEPHEN SLANA, M.D., S.C.
Entity Type:Organization
Organization Name:V. STEPHEN SLANA, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-654-0726
Mailing Address - Street 1:6125 GREEN BAY RD STE 800
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2982
Mailing Address - Country:US
Mailing Address - Phone:262-654-0726
Mailing Address - Fax:262-654-4365
Practice Address - Street 1:6125 GREEN BAY RD STE 800
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2982
Practice Address - Country:US
Practice Address - Phone:262-654-0726
Practice Address - Fax:262-654-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32916207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1730155573OtherNPI
WI1891761524OtherNPI
WI31792900Medicaid
WI34243100Medicaid
WI000132285Medicare ID - Type Unspecified
WIHOO375Medicare UPIN
WI31792900Medicaid
WI34243100Medicaid