Individual
KENNETH S FABRIC
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5150 N PORT WASHINGTON RD, #251, MILWAUKEE, WI 53217-5474
(414) 332-0606
(414) 967-3604
Mailing address
5150 N PORT WASHINGTON RD, #251, MILWAUKEE, WI 53217-5474
(414) 332-0606
(414) 967-3604
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
16433
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30937400
—
WI
01
—
73843
DMERC
WI
Enumeration date
05/18/2006
Last updated
07/08/2007
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