Individual
KENNETH B. GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10000 W BLUEMOUND RD, WAUWATOSA, WI 53226-4321
(414) 454-8000
(414) 805-3888
Mailing address
10000 W BLUEMOUND RD, WAUWATOSA, WI 53226-4321
(414) 454-8000
(414) 805-3888
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
036086146
IL
207N00000X
Dermatology Physician
Primary
66663
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790865806
—
WI
Enumeration date
10/16/2006
Last updated
07/26/2022
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