Individual
KELLY A MATHES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
333 N GREEN BAY RD, NEENAH, WI 54956-1954
(920) 729-6088
(920) 729-6484
Mailing address
333 N GREEN BAY RD, NEENAH, WI 54956-1954
(920) 729-6088
(920) 729-6484
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
67780-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100070814
—
WI
01
—
1044793358
AMERICAN BOARD OF FAMILY MEDICINE
—
Enumeration date
06/12/2014
Last updated
03/29/2022
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