Provider Demographics
NPI:1245337310
Name:FEHR, KEVIN E (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:FEHR
Suffix:
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 1:2901 W. BELTLINE HWY.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4226
Mailing Address - Country:US
Mailing Address - Phone:608-443-5603
Mailing Address - Fax:608-441-1981
Practice Address - Street 1:3434 E. WASHINGTON AVE.
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4155
Practice Address - Country:US
Practice Address - Phone:608-443-5550
Practice Address - Fax:608-443-5554
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40121-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32520700Medicaid
WI003774225Medicare ID - Type UnspecifiedWISCONSIN MC PROV #
WI32520700Medicaid