Healthcare Provider Details

I. General information

NPI: 1699465716
Provider Name (Legal Business Name): KRISHNA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 GREEN BAY RD
KENOSHA WI
53142-1450
US

IV. Provider business mailing address

7117 GREEN BAY RD
KENOSHA WI
53142-1450
US

V. Phone/Fax

Practice location:
  • Phone: 262-942-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6002287
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: