Individual
KYLE JUSTIN DUBOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 942-5600
(262) 948-7388
Mailing address
2901 W KINNICKINNIC RIVER PKWY STE 309, MILWAUKEE, WI 53215-3660
(414) 649-1292
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
67393
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100068480
—
WI
Enumeration date
02/20/2016
Last updated
09/05/2023
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