Healthcare Provider Details

I. General information

NPI: 1447388350
Provider Name (Legal Business Name): ROBERT EARL KERWIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E. CAMPUS MALL
MADISON WI
53715-1381
US

IV. Provider business mailing address

333 E. CAMPUS MALL
MADISON WI
53715-1381
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-5600
  • Fax: 608-263-6884
Mailing address:
  • Phone: 608-265-5600
  • Fax: 608-263-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number33394
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: