Faithful Physician Services LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

53437-20 Issued in WI

Legal business name

FAITHFUL PHYSICIAN SERVICES LLC

Doing business as

Faithful Physician Services

Practice address

1109 Cecelia Drive
Pewaukee, WI 53072-2524

Phone

(262) 373-6733

Fax

(262) 373-6018

NPI assigned

Dec 20, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Steven Mather Kotsonis, M.D.

Title

Owner

Phone

(262) 373-6733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Faithful Physician Services Doing business as

Locations

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

{
    "created_epoch": "1450569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530057600000",
    "number": "1467817320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12420 W HAMPTON AVE #89",
            "city": "BUTLER",
            "state": "WI",
            "postal_code": "530070089",
            "telephone_number": "262-373-6733",
            "fax_number": "262-373-6018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 CECELIA DRIVE",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530722524",
            "telephone_number": "262-373-6733",
            "fax_number": "262-373-6018"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "347 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Pewaukee",
            "state": "WI",
            "postal_code": "530723413",
            "country_code": "US",
            "telephone_number": "262-373-6733",
            "fax_number": "262-373-6018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAITHFUL PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-20",
        "last_updated": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "KOTSONIS",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "MATHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-373-6733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "53437-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100031662",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Faithful Physician Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Faithful Physician Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; 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.