Individual
KENNETH K OH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2817 NEW PINERY RD., DIVINE SAVIOR HEALTHCARE INC, PORTAGE, WI 53901-0387
(608) 742-4131
(608) 742-0362
Mailing address
2817 NEW PINERY RD., DIVINE SAVIOR HEALTHCARE INC, PORTAGE, WI 53901-0387
(608) 742-4131
(608) 742-0362
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
41268020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32590300
—
WI
Enumeration date
11/22/2005
Last updated
01/31/2012
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