Individual
KEVEN R MOTTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
3400 MARKET LN, KENOSHA, WI 53144-3430
(262) 551-4600
(262) 551-4630
Mailing address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 656-0044
(262) 653-2218
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1868
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12006222
CAQH
—
Enumeration date
05/25/2006
Last updated
08/31/2020
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