Healthcare Provider Details

I. General information

NPI: 1609553858
Provider Name (Legal Business Name): KACIE KARCZEWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 75TH ST STE 304
KENOSHA WI
53142-7884
US

IV. Provider business mailing address

10400 75TH ST STE 304
KENOSHA WI
53142-7884
US

V. Phone/Fax

Practice location:
  • Phone: 262-948-7810
  • Fax:
Mailing address:
  • Phone: 262-948-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8939-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: