Healthcare Provider Details

I. General information

NPI: 1992055925
Provider Name (Legal Business Name): MR. KENT L PERKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4262 N 89TH ST
MILWAUKEE WI
53222-1759
US

IV. Provider business mailing address

4262 N 89TH ST
MILWAUKEE WI
53222-1759
US

V. Phone/Fax

Practice location:
  • Phone: 414-510-9246
  • Fax: 414-939-7110
Mailing address:
  • Phone: 414-510-9246
  • Fax: 414-939-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number146L00000X
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number37-1659913
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: