Individual
KENNETH B. BORTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-4990
(262) 245-2655
Mailing address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-4990
(262) 245-2655
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
26253-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30583300
—
WI
Enumeration date
12/15/2006
Last updated
08/09/2016
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