# KEVIN L O'HALLORAN MD SC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Orthopedic Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164431367
- **Authorized official:** KEVIN L O'HALLORAN MD (OWNER)
- **Authorized official phone:** (920) 261-0672

## Contact information

- **Practice address:** 123 HOSPITAL DR, SUITE 1008, WATERTOWN, WI 53098-3331
- **Practice address phone:** (920) 261-0672
- **Practice address fax:** (920) 261-0682
- **Mailing address:** 123 HOSPITAL DR, SUITE 1008, WATERTOWN, WI 53098-3331
- **Mailing address phone:** (920) 261-0672
- **Mailing address fax:** (920) 261-0682

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 34258 | WI | Yes |

## Other

- **Enumeration date:** 08/05/2006
- **Last updated:** 02/26/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 31932100 | — | WI |