Edward T Stevens MD SC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

22919020 Issued in WI

Legal business name

EDWARD T STEVENS MD SC

Practice address

600 52ND Street
Suite 240
Kenosha, WI 53140-3423

Phone

(262) 656-0006

Fax

(262) 656-0005

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Edward Terrance Stevens, MD

Title

President

Phone

(262) 656-0006

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962521716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 52ND STREET",
            "address_2": "SUITE 240",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403423",
            "telephone_number": "262-656-0006",
            "fax_number": "262-656-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 52ND STREET",
            "address_2": "SUITE 240",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403423",
            "telephone_number": "262-656-0006",
            "fax_number": "262-656-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD T STEVENS MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "TERRANCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-656-0006",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "22919020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30305400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neurology Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Neurology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.