MEDICARE: KRISTIN ELIZABETH DEMENT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	66276	WI

General Provider Information

NPI Number	:	1205220233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ELIZABETH DEMENT D.O.

Provider Business Mailing Address
First Line	:	1700 PARADISE DR
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-9795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 W LOOMIS RD
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2448
Country	:	US
Telephone Number	:	414-423-0555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	08/13/2024

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