Healthcare Provider Details

I. General information

NPI: 1154434181
Provider Name (Legal Business Name): JANE M. KOTCHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE E. MORLEY KOTCHEN MD

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 W WATERTOWN PLANK RD DEPARTMENT OF POPULATION HEALTH CLINIC
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

8701 W WATERTOWN PLANK RD DEPARTMENT OF POPULATION HEALTH CLINIC
MILWAUKEE WI
53226-3548
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-8201
  • Fax: 414-955-6554
Mailing address:
  • Phone: 414-955-8201
  • Fax: 414-955-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number33284
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: