Individual
SUSAN K. KINAST-PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
(262) 245-2227
Mailing address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
(262) 245-2227
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
23108-20
WI
208M00000X
Hospitalist Physician
Primary
23108-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942229331
BCBSWI
WI
05
—
1942229331
—
WI
05
—
30467900
—
WI
01
—
61018
DEAN HEALTH INSURANCE
WI
01
—
KINASSUS
MERCYCARE INSURANCE
WI
Enumeration date
07/18/2006
Last updated
10/03/2013
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