Individual
KELLY A ZALOG
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
19035 W CAPITOL DR, SUITE 101, BROOKFIELD, WI 53045-2706
(262) 754-1421
(262) 754-3760
Mailing address
6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
(414) 423-4100
(414) 423-4134
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
715-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42942500
—
WI
Enumeration date
01/18/2006
Last updated
07/08/2007
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