Individual
KRISTEN VACCARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
8701 WATERTOWN PLANK RD, MILWAUKEE, WI 53226-3548
(414) 955-1925
Mailing address
19 FOREST GATE CIR, OAK BROOK, IL 60523-2129
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
100231
WI
390200000X
Student in an Organized Health Care Education/Training Program
125.079357
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100231-851
WISCONSIN MEDICAL EXAMINING BOARD RESIDENT EDUCATION LICENSE
WI
01
—
125.079357
DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
03/23/2022
Last updated
06/27/2023
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