Gordon, Kenneth B.

Gordon, Kenneth B. is an individual health care provider with primary practice located at 10000 W Bluemound Rd , Wauwatosa WI 53226-4321. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Gordon, Kenneth B. can be contacted via phone (414) 454-8000.

Contact Information

Primary practice address
10000 W Bluemound Rd Wauwatosa WI 53226-4321
Phone: (414) 454-8000
Fax: (414) 805-3888
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 036086146 Illinois
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 66663 Wisconsin

Profile Details

NPI number 1790865806
LBN Legal business name Gordon, Kenneth B.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 16th, 2006
Last updated Jul 26th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790865806 NPPES
Wisconsin MEDICAID 1790865806

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