Individual
JEREMY S KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10 N WATER ST, EVANSVILLE, WI 53536-1152
(608) 882-5170
(608) 882-6532
Mailing address
10 N WATER ST, EVANSVILLE, WI 53536-1152
(608) 882-5170
(608) 882-6532
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
75634-21
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437715380
—
WI
Enumeration date
05/16/2019
Last updated
08/29/2022
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