=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578611703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANITA I. INVEISS, M.D., S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3618 8TH AVE SUITE 12
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53140-2576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-654-0260
-----------------------------------------------------
Fax | 262-654-8577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3618 8TH AVE SUITE 12
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53140-2576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-654-0260
-----------------------------------------------------
Fax | 262-654-8577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANITA ILZE INVEISS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 262-654-0765
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 25956
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------