Individual ProviderStefan IdsoStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address1801 W Wisconsin Ave, Milwaukee, WI 53233-2186(414) 534-5686PECOS EnrollmentBased on the most recent information from CMS, provider Stefan Idso does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1184205866Provider TypeIndividualFull NameIdso, StefanGenderMaleSole ProprietorNoEnumeration Date4/15/2021Last Updated4/15/2021Contact InformationPractice LocationPractice Address1801 W Wisconsin Ave, Milwaukee, WI 53233-2186Phone(414) 534-5686FaxUnlisted FaxMailing LocationMailing Address1801 W Wisconsin Ave, Milwaukee, WI 53233-2186PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer