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NPI Code Detail

MEDICARE: KATHLEEN M PHELAN M.D.

MEDICARE: KATHLEEN M PHELAN M.D.
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
1207Q00000XFamily Medicine Physician37057WI

General Provider Information

NPI Number : 1871566182
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN M PHELAN M.D.
Provider Business Mailing Address
First Line : 1500 WALNUT RIDGE DR
Second Line : PROHEALTH CARE MEDICAL ASSOCIATES INC.
City : HARTLAND
State : WI
Zip : 53029-9317
Country : US
Telephone Number : 262-928-7500
Fax Number : 262-367-8744
Provider Business Practice Location Address
First Line : 1500 WALNUT RIDGE DR
Second Line : PROHEALTH CARE MEDICAL ASSOCIATES INC.
City : HARTLAND
State : WI
Zip : 53029-9317
Country : US
Telephone Number : 262-928-7500
Fax Number : 262-367-8744
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 04/20/2012

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