MEDICARE: KENNETH ROBY

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	172A00000X	Driver		WI

General Provider Information

NPI Number	:	1558228866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH ROBY

Provider Business Mailing Address
First Line	:	7862 W APPLETON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5309
Country	:	US
Telephone Number	:	414-921-8723
Fax Number	:

Provider Business Practice Location Address
First Line	:	7862 W APPLETON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5309
Country	:	US
Telephone Number	:	414-921-8723
Fax Number	:

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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