Individual
DR. GARY LEE LEE KOLESARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1121 E NORTH AVE, COLUMBIA-ST. MARY'S FAMILY MEDICINE, MILWAUKEE, WI 53212-3515
(414) 267-6502
(414) 267-3892
Mailing address
1121 E NORTH AVE, COLUMBIA-ST. MARY'S FAMILY MEDICINE, MILWAUKEE, WI 53212-3515
(414) 267-6502
(414) 267-3892
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21749
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000122U
HUMANA
—
05
—
1326099169
—
WI
Enumeration date
05/15/2006
Last updated
03/04/2014
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