Individual
KYLE GOHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
W180N8085 TOWN HALL RD, DEPT OF ANESTHESIOLOGY, MENOMONEE FALLS, WI 53051-3518
(262) 257-5100
Mailing address
W180N8085 TOWN HALL RD, DEPT OF ANESTHESIOLOGY, MENOMONEE FALLS, WI 53051-3518
(262) 257-5100
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
006981
GA
367H00000X
Anesthesiologist Assistant
Primary
7717
WI
Other
Enumeration date
10/23/2013
Last updated
06/22/2016
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