Individual
KENNETH JOE GARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
105 4TH AVE, SHELL LAKE, WI 54871-0189
(715) 468-2711
(715) 468-2727
Mailing address
PO BOX 189, SHELL LAKE, WI 54871-0189
(715) 468-2711
(715) 468-2727
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
45490
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
266R9GA
COMPREHENSIVE CARE SVS
MN
05
—
34380700
—
WI
Enumeration date
07/12/2005
Last updated
07/09/2007
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