Individual
KEVIN ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-8664
(414) 955-0064
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 955-8664
(414) 955-0064
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
73096
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871023713
—
WI
Enumeration date
06/13/2017
Last updated
06/05/2021
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