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Individual

KELLY SANDBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2801 W KINNICKINNIC RIVER PKWY STE 145, MILWAUKEE, WI 53215-3624
(414) 649-3240
(414) 649-3244
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 385-2301
(414) 385-8791

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036.150493
IL
208600000X
Surgery Physician
Primary
23036
WI
208600000X
Surgery Physician
O-1388
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100215196
WI
Enumeration date
02/28/2014
Last updated
06/08/2023
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