Provider Demographics
NPI:1104184100
Name:KAEPPLER, MARK J
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:KAEPPLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W180N11070 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3109
Mailing Address - Country:US
Mailing Address - Phone:262-535-8400
Mailing Address - Fax:
Practice Address - Street 1:W180N11070 RIVER LN
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3109
Practice Address - Country:US
Practice Address - Phone:262-535-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65453207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease