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General NPI Number Information
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NPI Number | 1508831926
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Entity Type | Individual
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Provider Name | KEVIN DWAYNE IZARD M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 13700 W NATIONAL AVE SUITE 128
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City | NEW BERLIN
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State | WI
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Zip | 53151-9521
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Country | US
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Telephone | 414-217-4909
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Fax | 978-291-1897
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Provider Business Mailing Address
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Address Line | 2856 N GRANT BLVD
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City | MILWAUKEE
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State | WI
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Zip | 53210-2424
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Country | US
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Telephone | 414-871-7250
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38516
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License Number State | WI
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