Individual
KENNETH RICHARD TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
Mailing address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
73725-20
WI
2083A0100X
Aerospace Medicine Physician
23942
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090552
—
WI
Enumeration date
04/15/2014
Last updated
04/24/2023
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