Individual
DR. KEITH T OLDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC SURGERY, MILWAUKEE, WI 53226-4874
(414) 266-6550
(414) 266-6579
Mailing address
9000 W WISCONSIN AVE, PEDIATRIC SURGERY, MILWAUKEE, WI 53226-4874
(414) 266-6550
(414) 266-6579
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
40362
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000328Q
HUMANA
—
05
—
1023060753
—
WI
Enumeration date
05/17/2006
Last updated
03/02/2023
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