MEDICARE: DR. KIRSTIN M CERTALIC DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	40646	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275542326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRSTIN M CERTALIC DO

Provider Business Mailing Address
First Line	:	2315 E MORELAND BLVD
Second Line	:	WESTBROOK WALK-IN CLINIC
City	:	WAUKESHA
State	:	WI
Zip	:	53186-2939
Country	:	US
Telephone Number	:	262-532-5800
Fax Number	:	262-532-5760

Provider Business Practice Location Address
First Line	:	2315 E MORELAND BLVD
Second Line	:	WESTBROOK WALK-IN CLINIC
City	:	WAUKESHA
State	:	WI
Zip	:	53186-2939
Country	:	US
Telephone Number	:	262-532-5800
Fax Number	:	262-532-5760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	03/07/2023

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