Provider Demographics
NPI:1265407316
Name:URLAKIS, KENNETH JR (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:URLAKIS
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 VIOLET CT
Mailing Address - Street 2:
Mailing Address - City:COLGATE
Mailing Address - State:WI
Mailing Address - Zip Code:53017-9319
Mailing Address - Country:US
Mailing Address - Phone:262-388-6217
Mailing Address - Fax:
Practice Address - Street 1:631 VIOLET CT
Practice Address - Street 2:
Practice Address - City:COLGATE
Practice Address - State:WI
Practice Address - Zip Code:53017-9319
Practice Address - Country:US
Practice Address - Phone:262-388-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37072207Q00000X
WI37072-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32309000Medicaid
WI32309000Medicaid
WI32309000Medicaid