Provider Demographics
NPI:1508831926
Name:IZARD, KEVIN DWAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DWAYNE
Last Name:IZARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2856 N GRANT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2424
Mailing Address - Country:US
Mailing Address - Phone:414-871-7250
Mailing Address - Fax:
Practice Address - Street 1:13700 W NATIONAL AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-9521
Practice Address - Country:US
Practice Address - Phone:414-217-4909
Practice Address - Fax:978-291-1897
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI38516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine