Organization
KENNETH J GARRISON, MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH JOE GARRISON M D (PRESIDENT)
(715) 822-3654
Entity
Organization
Contact information
Practice address
105 4TH AVE, SHELL LAKE, WI 54871-0189
(715) 468-2711
(715) 468-2727
Mailing address
P O BOX 189, 105 4TH AVE, SHELL LAKE, WI 54871-0189
(715) 468-2711
(715) 468-2727
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
45490
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108390
HEALTH PARTNERS
MN
01
—
1701193
SELECTCARE
WI
01
—
1701194
SELECTCARE
WI
01
—
26097135226
PREFERRED ONE
MN
01
—
266R0GA
COMPREHENSIVE CARE SVS
MN
05
—
34380700
—
WI
01
—
5999172200
MN MEDICAID
MN
01
—
P00013163
RAILROAD MEDICARE
WI
Enumeration date
11/16/2006
Last updated
08/22/2020
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