Organization
KESTREL MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE M JOHNSON (OWNER)
(262) 354-0764
Entity
Organization
Contact information
Practice address
888 THACKERAY TRL STE 105, OCONOMOWOC, WI 53066-4342
(262) 354-0764
Mailing address
888 THACKERAY TRL STE 105, OCONOMOWOC, WI 53066-4342
(262) 354-0764
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
03/15/2018
Last updated
01/19/2021
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