Heidle, Kelly Beth

Heidle, Kelly Beth is an individual health care provider with primary practice located at 6308 8Th Ave , Kenosha WI 53143-5031. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Heidle, Kelly Beth can be contacted via phone (414) 290-6720.

Contact Information

Primary practice address
6308 8Th Ave Kenosha WI 53143-5031
Phone: (414) 290-6720
Fax: (414) 290-6755
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 67122-21 Wisconsin
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X OS018162 Pennsylvania

Profile Details

NPI number 1992044846
LBN Legal business name Heidle, Kelly Beth
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 12th, 2013
Last updated Dec 28th, 2021 - about 5 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 1992044846 NPPES
Pennsylvania Other 0182229 OHIO MEDICAID
Pennsylvania MEDICAID 1031239290001 OHIO MEDICAID
Pennsylvania Other 003403181 OHIO MEDICAID

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