Provider Demographics
NPI:1295887321
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SLANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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
Practice Address - Street 2:SUITE 800
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2928
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:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332H00000XSuppliersEyewear Supplier