Individual
MS. KIRSTEN R KALLIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCP, LP
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 259-3000
Mailing address
S84W23478 SHERMAN LN, BIG BEND, WI 53103-9233
(262) 442-8064
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
100-018
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
089006-0653
AMERICAN BOARD OF CARDIOVASCULAR PERFUSION
—
01
—
100-018
WISCONSIN DEPARTMENT OF REGULATION AND LICENSING
WI
Enumeration date
11/25/2020
Last updated
11/25/2020
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