Provider Demographics
NPI:1265467815
Name:BERRYHILL, KENYITA TAMARA (MD)
Entity Type:Individual
Prefix:
First Name:KENYITA
Middle Name:TAMARA
Last Name:BERRYHILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 S 103RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4161
Mailing Address - Country:US
Mailing Address - Phone:414-321-3951
Mailing Address - Fax:414-321-8307
Practice Address - Street 1:3365 S 103RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4161
Practice Address - Country:US
Practice Address - Phone:414-321-3951
Practice Address - Fax:414-321-8307
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47935208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1265467815Medicaid