NPIMap

Organization Active NPI

Kenosha Urology Clinic, S.C.

  • Urology Physician
  • Kenosha, WI
National Provider Identifier
1396831343
Registry record updated Jun 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
308295 Issued in WI
Legal business name
KENOSHA UROLOGY CLINIC, S.C.
Practice address
6308 8TH Ave
Suite 503
Kenosha, WI 53143-5031
Phone
(262) 656-8213
Fax
(262) 656-8233
NPI assigned
Oct 5, 2006
Last updated
Jun 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ned R. Novsam, M.D.NPI 1760413900
Title
Vice-President
Phone
(262) 656-8213

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X 308295 WI Primary

Addresses

Primary practice location

6308 8TH Ave
Suite 503
Kenosha, WI 53143-5031

Mailing address

6308 8TH Ave
Suite 503
Kenosha, WI 53143-5031
Phone (262) 656-8213

Other identifiers 1

IdentifierTypeStateIssuer
32729100MedicaidWI

National Provider Directory

National Provider Directory

Locations

6308 8th Ave
#503
Kenosha, WI 53143
Phone (262) 656-8213

6308 8th Ave
Ste 503
Kenosha, WI 53143
Phone (262) 656-8213

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1396831343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "address_2": "SUITE 503",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435031",
            "telephone_number": "262-656-8213",
            "fax_number": "262-656-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "address_2": "SUITE 503",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435031",
            "telephone_number": "262-656-8213",
            "fax_number": "262-656-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA UROLOGY CLINIC, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "NOVSAM",
        "authorized_official_first_name": "NED",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "262-656-8213",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "WI",
            "license": "308295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32729100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.