Provider Demographics
NPI:1508834193
Name:KIDD, CHARLES F (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:KIDD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2801 W. KINNICKINNIC RIVER PARKWAY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-672-6006
Mailing Address - Fax:414-672-6016
Practice Address - Street 1:2801 W. KINNICKINNIC RIVER PARKWAY
Practice Address - Street 2:SUITE 370
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-672-6006
Practice Address - Fax:414-672-6016
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI46512020208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34472100Medicaid
WI340020435OtherMEDICARE RAILROAD
WI34472100Medicaid
WI340020435OtherMEDICARE RAILROAD