Individual
MR. STEPHEN G KENNEBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-8700
Mailing address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-8786
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1043
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42973600
—
WI
Enumeration date
07/26/2005
Last updated
11/26/2021
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