Individual
MRS. KELLYN JEAN DOERGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9200 WEST WISCONSIN AVE, CLINICAL CANCER CENTER 5TH FLOOR, MILWAUKEE, WI 53226-3596
(414) 805-0820
(414) 805-0988
Mailing address
9200 WEST WISCONSIN AVE, CLINICAL CANCER CENTER 5TH FLOOR, MILWAUKEE, WI 53226-3596
(414) 805-0820
(414) 805-0988
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2954-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831453745
—
WI
05
—
MB2668549
—
WI
Enumeration date
06/26/2012
Last updated
12/10/2014
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