Individual
KEGAN D JULIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9200 W WISCONSIN AVE, DEPARTMENT OF INTERNAL MEDICINE, MILWAUKEE, WI 53226-3522
(414) 805-6850
(414) 805-6851
Mailing address
9200 W WISCONSIN AVE, DEPARTMENT OF INTERNAL MEDICINE, MILWAUKEE, WI 53226-3522
(414) 805-6850
(414) 805-6851
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2991-23
WI
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104186048
—
WI
Enumeration date
05/25/2012
Last updated
02/25/2014
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