Healthcare Provider Details

I. General information

NPI: 1114903481
Provider Name (Legal Business Name): CATHERINE D KEULKS-TORINUS P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 E SUMMIT AVE
OCONOMOWOC WI
53066-3844
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 262-569-0251
  • Fax: 262-569-0342
Mailing address:
  • Phone: 414-423-4100
  • Fax: 414-423-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number780-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: