Stalivonenko, Dmitriy
Stalivonenko, Dmitriy is an individual health care provider with primary practice located at 10400 75Th St , Kenosha WI 53142-7884. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Stalivonenko, Dmitriy can be contacted via phone (414) 358-5443.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 40879-020 | Wisconsin |
Profile Details
| NPI number | 1710966395 |
|---|---|
| LBN Legal business name | Stalivonenko, Dmitriy |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 12th, 2006 |
| Last updated | Nov 6th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710966395 | NPPES |
| Wisconsin | MEDICAID | 34055600 |
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10400 75Th St , Kenosha WI 53142-7884