Individual
MERIAM KANIKUNNEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
801 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3204
(414) 290-6720
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, SUITE 2000, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.005940
IL
Other
Enumeration date
08/18/2016
Last updated
04/26/2021
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