Individual
KENNETH A GELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 730-6700
Mailing address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 730-6700
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
20142
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31232700
—
WI
Enumeration date
09/06/2005
Last updated
02/18/2010
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