Provider Demographics
NPI:1669727921
Name:KERWEL, THERESE G (MD)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:G
Last Name:KERWEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THERESE
Other - Middle Name:ANN
Other - Last Name:GANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17000 W NORTH AVE
Mailing Address - Street 2:SUITE 107W
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4423
Mailing Address - Country:US
Mailing Address - Phone:262-785-7740
Mailing Address - Fax:
Practice Address - Street 1:17000 W NORTH AVE
Practice Address - Street 2:SUITE 107W
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4423
Practice Address - Country:US
Practice Address - Phone:262-785-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61146208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery