Organization
KENOSHA EMERGENCY PHYSICIANS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN VAUGHN (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
6308 8TH AVE, KENOSHA, WI 53143-5031
(414) 290-6718
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6718
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020443300
FEDERAL BLACK LUNG PROGRA
WI
01
—
110009911
WEA
WI
01
—
137497601
OWCP
WI
05
—
32854800
—
WI
01
—
CD9325
MEDICARE RAILROAD
WI
Enumeration date
05/09/2006
Last updated
03/30/2023
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