MEDICARE: DR. KEVIN T. FLAHERTY M.D.

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	207W00000X	Ophthalmology Physician	30290	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	001239155	OTHER	WI	MEDICARE

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

General Provider Information

NPI Number	:	1740263581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN T. FLAHERTY M.D.

Provider Business Mailing Address
First Line	:	800 N 1ST ST
Second Line	:
City	:	WAUSAU
State	:	WI
Zip	:	54403-4754
Country	:	US
Telephone Number	:	715-261-8500
Fax Number	:	715-261-8667

Provider Business Practice Location Address
First Line	:	800 N 1ST ST
Second Line	:
City	:	WAUSAU
State	:	WI
Zip	:	54403-4754
Country	:	US
Telephone Number	:	715-261-8500
Fax Number	:	715-261-8667

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	11/17/2025

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