Individual
KYLE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY, MILWAUKEE, WI 53215-3669
(414) 649-6732
Mailing address
2801 W KINNICKINNIC RIVER PKWY, MILWAUKEE, WI 53215-3669
(414) 649-6732
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56630-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/22/2010
Last updated
11/22/2021
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