Provider Demographics
NPI:1023098654
Name:KENYON LAUNDRE, CHRISTINE A (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:KENYON LAUNDRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:A
Other - Last Name:KENYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:SUITE 453
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3669
Mailing Address - Country:US
Mailing Address - Phone:414-385-2380
Mailing Address - Fax:414-385-2382
Practice Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:SUITE 453
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-385-2380
Practice Address - Fax:414-385-2382
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47955207L00000X
WI53794-20207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN314618900Medicaid
IAENROLLEDMedicaid
WI35170100Medicaid
I42027Medicare UPIN
MN314618900Medicaid
MN050001902Medicare PIN
MN050002083Medicare PIN