MEDICARE: CHRISTOPHER KEARNS MD

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	208800000X	Urology Physician	31567	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396732806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER KEARNS MD

Provider Business Mailing Address
First Line	:	788 N JEFFERSON ST
Second Line	:	SUITE 300 / ATTN. KAAREN BUTZEN
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3718
Country	:	US
Telephone Number	:	414-272-8950
Fax Number	:	414-272-0859

Provider Business Practice Location Address
First Line	:	13133 N PORT WASHINGTON RD
Second Line	:	SUITE 204
City	:	MEQUON
State	:	WI
Zip	:	53097-2419
Country	:	US
Telephone Number	:	262-243-2524
Fax Number	:	262-243-2525

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	11/09/2016

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