Individual
DR. JESSE VARNEY DEGROAT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-5630
(262) 687-5657
Mailing address
709 SHERIDAN RD, KENOSHA, WI 53140-1137
(262) 552-9137
(262) 687-5657
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44111-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3224200
—
WI
Enumeration date
03/01/2006
Last updated
08/23/2011
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