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General NPI Number Information
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NPI Number | 1265698690
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Entity Type | Individual
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Provider Name | KELLI LOUISE SASADA M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 9555 76TH ST SUITE 4105
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1984
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Country | US
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Telephone | 262-577-8080
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Fax | 262-577-8081
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Provider Business Mailing Address
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Address Line | 9555 76TH ST SUITE 4105
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1984
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Country | US
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Telephone | 262-577-8080
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Fax | 262-577-8081
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | MD60215747
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 57485
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License Number State | WI
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