Healthcare Provider Details

I. General information

NPI: 1407105968
Provider Name (Legal Business Name): KATHERINE TERESA RINGLER IVERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE TERESA RINGLER

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-1700
  • Fax: 414-955-0072
Mailing address:
  • Phone: 414-955-1700
  • Fax: 414-955-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA136855
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number76049
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number76049
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number76049
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: