Individual
KERRY LEE MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
W180N7950 TOWN HALL RD, MENOMONEE FALLS, WI 53051-4049
(262) 250-5158
(262) 532-9505
Mailing address
W180N7950 TOWN HALL RD, MENOMONEE FALLS, WI 53051-4049
(262) 250-5158
(262) 532-9505
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
35-069786
OH
207V00000X
Obstetrics & Gynecology Physician
Primary
52512-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0239852
—
OH
05
—
100003501
—
WI
01
—
160044537
RAILROAD
OH
Enumeration date
03/21/2007
Last updated
11/04/2024
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