Individual
DR. KEVIN G DERUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
946 N VAN BUREN ST, MILWAUKEE, WI 53202-3216
(414) 276-4242
Mailing address
946 N VAN BUREN ST, MILWAUKEE, WI 53202-3216
(414) 276-4242
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
26546-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30648800
—
WI
Enumeration date
04/10/2006
Last updated
09/26/2012
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