Provider Demographics
NPI:1437477320
Name:VASCONCELLOS, KATE W (MD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:W
Last Name:VASCONCELLOS
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 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-649-3240
Mailing Address - Fax:414-649-3244
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 575
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-5200
Practice Address - Country:US
Practice Address - Phone:414-649-3240
Practice Address - Fax:414-649-3244
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-07351208600000X
GA76842208C00000X
WI22706208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100208986Medicaid