Provider Demographics
NPI:1730314253
Name:PERTTU, KIMBERLY A (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:PERTTU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11134 N STATE ROAD 77
Mailing Address - Street 2:ESSENTIA HEALTH HAYWARD CLINIC
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-5325
Mailing Address - Country:US
Mailing Address - Phone:715-634-5505
Mailing Address - Fax:
Practice Address - Street 1:11134 N STATE ROAD 77
Practice Address - Street 2:ESSENTIA HEALTH HAYWARD CLINIC
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-5325
Practice Address - Country:US
Practice Address - Phone:715-634-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64349-21207Q00000X, 207Q00000X
MIKP018428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381368347OtherTIN
MI0A37669Medicare PIN