Individual
MR. KIP TYLER MENTZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
115 N SWEETWATER BLVD, PORT WASHINGTON, WI 53074-2657
(920) 476-6400
Mailing address
115 N SWEETWATER BLVD, PORT WASHINGTON, WI 53074-2657
(419) 674-6590
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
54515-20
WI
Other
Enumeration date
04/14/2008
Last updated
09/19/2024
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