Provider Demographics
NPI:1295063485
Name:MICHELKAMP, KURT D (RN)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:D
Last Name:MICHELKAMP
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 NORTH POINT DR
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1233
Mailing Address - Country:US
Mailing Address - Phone:715-341-6970
Mailing Address - Fax:
Practice Address - Street 1:7948 COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:ALMOND
Practice Address - State:WI
Practice Address - Zip Code:54909-9556
Practice Address - Country:US
Practice Address - Phone:715-366-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI146810-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI146810-030OtherRN LICENSE
WI35033900Medicaid