Healthcare Provider Details

I. General information

NPI: 1689308090
Provider Name (Legal Business Name): JEFFREY KOBINSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 W RIVER WOODS PKWY STE 225
GLENDALE WI
53212-1088
US

IV. Provider business mailing address

377 W RIVER WOODS PKWY STE 225
GLENDALE WI
53212-1088
US

V. Phone/Fax

Practice location:
  • Phone: 414-443-0200
  • Fax:
Mailing address:
  • Phone: 414-443-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: