Healthcare Provider Details

I. General information

NPI: 1265467815
Provider Name (Legal Business Name): KENYITA TAMARA BERRYHILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 S 103RD ST SUITE 100
MILWAUKEE WI
53227-4161
US

IV. Provider business mailing address

3365 S 103RD ST SUITE 100
MILWAUKEE WI
53227-4161
US

V. Phone/Fax

Practice location:
  • Phone: 414-321-3951
  • Fax: 414-321-8307
Mailing address:
  • Phone: 414-321-3951
  • Fax: 414-321-8307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47935
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: