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Individual

MS. JACQUELINE KAZIK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PAC

Contact information

Practice address
PLANK ROAD CLINIC, 1155 NORTH MAYFAIR ROAD, MILWAUKEE, WI 53226
(414) 456-5990
Mailing address
1155 N MAYFAIR RD, PLANK ROAD CLINIC, MILWAUKEE, WI 53226-3421

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
434-023
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
003000261N
HUMANA
05
42916700
WI
Enumeration date
05/20/2006
Last updated
09/24/2008
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