Provider Demographics
NPI:1174639546
Name:HALBERT, KEVIN EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EUGENE
Last Name:HALBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 N. 51ST STREET
Mailing Address - Street 2:SUITE P309
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1661
Mailing Address - Country:US
Mailing Address - Phone:414-447-2663
Mailing Address - Fax:414-447-2884
Practice Address - Street 1:3070 N. 51ST STREET
Practice Address - Street 2:SUITE P309
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1661
Practice Address - Country:US
Practice Address - Phone:414-447-2663
Practice Address - Fax:414-447-2884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI377152080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32230700Medicaid
WI32230700Medicaid
F80781Medicare UPIN