Organization
KETAMINE MILWAUKEE, SC
Active
Other names
Edelica
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN KANE MD (PRESIDENT)
(414) 206-1606
Entity
Organization
Contact information
Practice address
10424 W BLUEMOUND RD, MILWAUKEE, WI 53226-4331
(414) 206-1606
Mailing address
2942 N INTERLAKEN DR, OCONOMOWOC, WI 53066-4910
(414) 206-1606
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
11/18/2024
Last updated
11/18/2024
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