Individual
DR. KEITH R. ANCLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
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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