Individual
DR. KELLY HENRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9000 W WISCONSIN AVE, PEDIATRIC INFECTIOUS DISEASE, MILWAUKEE, WI 53226-4874
(414) 337-7070
(414) 337-7093
Mailing address
9000 W WISCONSIN AVE, PEDIATRIC INFECTIOUS DISEASE, MILWAUKEE, WI 53226-4874
(414) 337-7070
(414) 337-7093
Taxonomy
Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
31214
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000198G
HUMANA
—
05
—
1033161708
—
WI
Enumeration date
05/17/2006
Last updated
02/26/2014
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