Individual
DR. KRISTINE M WAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
750 ROUND VALLEY DR STE 102, PARK CITY, UT 84060-7549
(435) 655-0926
(435) 649-3748
Mailing address
9000 W WISCONSIN AVE # MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-6238
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12807093-1205
UT
208000000X
Pediatrics Physician
41975
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932216975
—
WI
Enumeration date
08/24/2006
Last updated
03/07/2023
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