Individual
KENGO SEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2658
WI
363A00000X
Physician Assistant
9798
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203242200
—
MN
05
—
41973200
—
WI
Enumeration date
07/09/2006
Last updated
11/17/2022
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