MEDICARE: MR. STEPHEN D. MEISSNER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	801-023	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01001617	OTHER	WI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184601213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN D. MEISSNER PA-C

Provider Business Mailing Address
First Line	:	3003 W GOOD HOPE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-2042
Country	:	US
Telephone Number	:	414-352-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 N RIVERCENTER DR
Second Line	:	SUITE 160
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3978
Country	:	US
Telephone Number	:	414-274-7220
Fax Number	:	414-274-7227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	11/23/2021

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Directions to “ MR. STEPHEN D. MEISSNER PA-C” Practice Location

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