Provider Demographics
NPI:1316018823
Name:TADYCH, KEVIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:TADYCH
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 1:7520 US HIGHWAY 51 S
Mailing Address - Street 2:STE A
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-8943
Mailing Address - Country:US
Mailing Address - Phone:888-444-2873
Mailing Address - Fax:608-467-1393
Practice Address - Street 1:7520 US HIGHWAY 51 S
Practice Address - Street 2:STE A
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-8943
Practice Address - Country:US
Practice Address - Phone:888-444-2873
Practice Address - Fax:608-467-1393
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29520-020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1052540001OtherDMERC
WI200022200Medicare PIN
WI000444000Medicare PIN
WIF27124Medicare UPIN
WI000444000Medicare ID - Type Unspecified