Individual
KEVIN JAMES MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3000
Mailing address
4012 W ANTHONY DR, FRANKLIN, WI 53132-7806
(920) 602-3048
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
13458
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100228688
—
WI
Enumeration date
01/19/2023
Last updated
10/24/2024
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