Organization
KETTLE MORAINE ANESTHESIOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM BROWNE (CLINIC ADMINISTRATOR)
(262) 334-5533
Entity
Organization
Contact information
Practice address
3200 PLEASANT VALLEY RD, WEST BEND, WI 53095-9274
(262) 334-5533
Mailing address
200 E WASHINGTON ST, P O BOX 8031, APPLETON, WI 54911-5490
(866) 313-0337
(920) 739-0124
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21261200
—
WI
Enumeration date
06/19/2006
Last updated
01/11/2010
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