Healthcare Provider Details

I. General information

NPI: 1629742804
Provider Name (Legal Business Name): KDH VENTURES & CONSULTING,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5163 N 57TH ST
MILWAUKEE WI
53218-4217
US

IV. Provider business mailing address

5163 N 57TH ST
MILWAUKEE WI
53218-4217
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-7032
  • Fax:
Mailing address:
  • Phone: 813-397-7032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: KEVIN HICKMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 813-397-7032