Individual
ROBERT R MCKIBBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 KILEY WAY, PLYMOUTH, WI 53073-5020
(920) 449-7000
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(920) 449-7000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11276
MN
363A00000X
Physician Assistant
Primary
5662
WI
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100197491
—
WI
Enumeration date
10/11/2006
Last updated
02/06/2023
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