Healthcare Provider Details

I. General information

NPI: 1629606405
Provider Name (Legal Business Name): KRISTEN LAURA KOLBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

923 E OTJEN ST
MILWAUKEE WI
53207-1809
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3240
  • Fax: 414-649-3244
Mailing address:
  • Phone: 303-253-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberML61070565
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number85249-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: