Provider Demographics
NPI:1235220302
Name:WILLIS, KAMEKEA C (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMEKEA
Middle Name:C
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMEKEA
Other - Middle Name:R
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4425 N PORT WASHINGTON RD
Mailing Address - Street 2:CSMCP CLINIC CREDENTIALING
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1082
Mailing Address - Country:US
Mailing Address - Phone:414-326-2218
Mailing Address - Fax:414-326-2208
Practice Address - Street 1:2311 N PROSPECT AVE
Practice Address - Street 2:PROSPECT MEDICAL COMMONS
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4445
Practice Address - Country:US
Practice Address - Phone:414-319-3000
Practice Address - Fax:414-319-3033
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061132A207R00000X
WI63616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine