Healthcare Provider Details

I. General information

NPI: 1134166093
Provider Name (Legal Business Name): DR. MARK KAMSLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 RICHARDS RD SUITE A
HARTLAND WI
53029-8321
US

IV. Provider business mailing address

1005 RICHARDS RD SUITE A
HARTLAND WI
53029-8321
US

V. Phone/Fax

Practice location:
  • Phone: 262-912-0263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36425020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: