| NPI | 1366724478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT STOLLENWERK Owner 262-691-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 681-25) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2013-04-25 |