Provider Demographics
NPI:1225204662
Name:GELSHENEN, KEVIN ROGERS (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROGERS
Last Name:GELSHENEN
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:N7516 W LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-4384
Mailing Address - Country:US
Mailing Address - Phone:847-302-0678
Mailing Address - Fax:
Practice Address - Street 1:N7516 W LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-4384
Practice Address - Country:US
Practice Address - Phone:847-302-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00619782085R0202X
LAMD.2030842085R0202X
IL036-1186742085R0202X
CAA1167572085R0202X
WI54833-202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4M058CV55Medicare PIN