Individual
DR. KEITH R. ANCLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
323 S 18TH AVE, STURGEON BAY, WI 54235-1401
(920) 746-0510
Mailing address
323 S 18TH AVE, STURGEON BAY, WI 54235-1401
(920) 746-0510
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
27906
WI
207R00000X
Internal Medicine Physician
Primary
27906
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27906
WI LICENSE
—
05
—
30027400
—
WI
Enumeration date
08/03/2006
Last updated
04/28/2023
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