Provider Demographics
NPI:1295909075
Name:KEHOE, HALEY E (DO)
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:E
Last Name:KEHOE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:HALEY
Other - Middle Name:E
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8800 WEST LINCOLN AVE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227
Mailing Address - Country:US
Mailing Address - Phone:414-897-8897
Mailing Address - Fax:414-897-8860
Practice Address - Street 1:8800 WEST LINCOLN AVE SUITE 100
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-897-8897
Practice Address - Fax:414-897-8860
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54403-21207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program