Healthcare Provider Details

I. General information

NPI: 1528053865
Provider Name (Legal Business Name): KIMBERLIE A WARD-COOPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N DR MARTIN LUTHER KING DR
MILWAUKEE WI
53212-2709
US

IV. Provider business mailing address

MILWAUKEE HEALTH SERVICES INC 2555 N DR MARTIN LUTHER KING DR
MILWAUKEE WI
53212-2709
US

V. Phone/Fax

Practice location:
  • Phone: 414-372-8080
  • Fax: 414-372-1893
Mailing address:
  • Phone: 414-372-8080
  • Fax: 414-372-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40884-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: