Healthcare Provider Details

I. General information

NPI: 1619943354
Provider Name (Legal Business Name): GIUSEPPE S MICELI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 GREEN BAY RD SUITE A
KENOSHA WI
53142-3532
US

IV. Provider business mailing address

7201-GREEN BAY ROAD SUITE A
KENOSHA WI
53142
US

V. Phone/Fax

Practice location:
  • Phone: 262-925-6565
  • Fax: 262-697-4291
Mailing address:
  • Phone: 262-925-6565
  • Fax: 262-697-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number524-025
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: