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General NPI Number Information
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NPI Number | 1164431367
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Entity Type | Organization
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Legal Business Name | KEVIN L O'HALLORAN MD SC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 123 HOSPITAL DR SUITE 1008
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City | WATERTOWN
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State | WI
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Zip | 53098-3331
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Country | US
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Telephone | 920-261-0672
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Fax | 920-261-0682
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Provider Business Mailing Address
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Address Line | 123 HOSPITAL DR SUITE 1008
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City | WATERTOWN
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State | WI
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Zip | 53098-3331
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Country | US
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Telephone | 920-261-0672
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Fax | 920-261-0682
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN L O'HALLORAN
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Credential | MD
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Telephone | 920-261-0672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 34258
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License Number State | WI
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