Healthcare Provider Details

I. General information

NPI: 1144676727
Provider Name (Legal Business Name): KEELY BORNOR BROWNING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13133 N PORT WASHINGTON RD STE G16
MEQUON WI
53097-2423
US

IV. Provider business mailing address

788 N JEFFERSON ST STE 300
MILWAUKEE WI
53202-3710
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-2500
  • Fax:
Mailing address:
  • Phone: 414-272-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number71014-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: