Individual
KENNETH E JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2323 N LAKE DR, BEHAVIORAL HEALTH, 7TH FLOOR, MILWAUKEE, WI 53211-4508
(414) 291-1620
(414) 291-5969
Mailing address
2323 N LAKE DR, BEHAVIORAL HEALTH, 7TH FLOOR, MILWAUKEE, WI 53211-4508
(414) 291-1620
(414) 291-5969
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
27684-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31466200
—
WI
Enumeration date
07/05/2006
Last updated
06/12/2012
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