Provider Demographics
NPI:1730155573
Name:SLANA, VICTOR STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:STEPHEN
Last Name:SLANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6125 GREEN BAY RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2928
Mailing Address - Country:US
Mailing Address - Phone:262-654-0726
Mailing Address - Fax:262-654-4365
Practice Address - Street 1:6125 GREEN BAY RD
Practice Address - Street 2:STE 800
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2928
Practice Address - Country:US
Practice Address - Phone:262-654-0726
Practice Address - Fax:262-654-4365
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI32916207W00000X
IL036082657207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31792900Medicaid
WI000132285Medicare ID - Type Unspecified
WI31792900Medicaid