Individual
DR. KENNETH RUSSELL WALLER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DVM, MS
Contact information
Practice address
2015 LINDEN DR, ROOM 2058, MADISON, WI 53706-1100
(608) 263-7656
Mailing address
2015 LINDEN DR, ROOM 2058, MADISON, WI 53706-1100
(608) 263-7656
Taxonomy
Speciality
Code
Description
License number
State
174M00000X
Veterinarian
090010797
IL
174M00000X
Veterinarian
Primary
6054
WI
174M00000X
Veterinarian
7379
IA
Other
Enumeration date
07/25/2012
Last updated
07/25/2012
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