Healthcare Provider Details

I. General information

NPI: 1093101792
Provider Name (Legal Business Name): KELLY GRAFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY WILT MD

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-337-7070
  • Fax: 414-337-7093
Mailing address:
  • Phone: 414-337-7070
  • Fax: 414-337-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number75678
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: