Provider Demographics
NPI:1851367585
Name:DEMBNY, KENNETH DELL II (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DELL
Last Name:DEMBNY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13405 JUNEAU BLVD
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-1723
Mailing Address - Country:US
Mailing Address - Phone:262-797-6176
Mailing Address - Fax:
Practice Address - Street 1:201 N MAYFAIR RD
Practice Address - Street 2:SUITE 530
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4216
Practice Address - Country:US
Practice Address - Phone:414-443-0033
Practice Address - Fax:414-443-0034
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35379020208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33331000Medicaid
WI33331000Medicaid