Healthcare Provider Details

I. General information

NPI: 1962453316
Provider Name (Legal Business Name): KATHLEEN R BECKMANN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE PEDIATRIC EMERGENCY MEDICINE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE PEDIATRIC EMERGENCY MEDICINE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2625
  • Fax: 414-266-2635
Mailing address:
  • Phone: 414-266-2625
  • Fax: 414-266-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number37696
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: