Provider Demographics
NPI:1437857489
Name:CHOW, KENNEDY GRACE (PA)
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:GRACE
Last Name:CHOW
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:788 N JEFFERSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3710
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-326-4145
Practice Address - Street 1:13133 N PORT WASHINGTON RD STE G16
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2423
Practice Address - Country:US
Practice Address - Phone:262-243-2500
Practice Address - Fax:262-243-5395
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2024-04-10
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Provider Licenses
StateLicense IDTaxonomies
WI7425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant