Provider Demographics
NPI:1518906288
Name:KINATEDER, MEGHAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:K
Last Name:KINATEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEGHAN
Other - Middle Name:T
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-542-2536
Mailing Address - Fax:262-542-2791
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 115
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-542-2536
Practice Address - Fax:262-542-2791
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50416-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34941000Medicaid
WI34941000Medicaid