Individual
LANE A. KISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2424 S 90TH ST, SUITE 306, WEST ALLIS, WI 53227-2455
(414) 328-8750
(414) 328-8751
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
18544
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31039300
—
WI
01
—
P00725802
RR MEDICARE
WI
Enumeration date
04/06/2006
Last updated
12/31/2012
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