Provider Demographics
NPI:1073586392
Name:ARNOLD, KEVIN J (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:N17W24100 RIVERWOOD DR
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:1500 WALNUT RIDGE DR
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9317
Practice Address - Country:US
Practice Address - Phone:262-928-7500
Practice Address - Fax:262-367-8744
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-11-02
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Provider Licenses
StateLicense IDTaxonomies
WI22939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30346200Medicaid
WI683750611Medicare PIN
WI000368295Medicare PIN
WIB51242Medicare UPIN