Provider Demographics
NPI:1700145091
Name:LEWOCZKO, KENNETH BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:BRIAN
Last Name:LEWOCZKO
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 1:600 HIGHLAND AVE., H4/831
Mailing Address - Street 2:UW HOSPITAL AND CLINICS
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792
Mailing Address - Country:US
Mailing Address - Phone:608-263-0192
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE., H4/831
Practice Address - Street 2:UW HOSPITAL AND CLINICS
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792
Practice Address - Country:US
Practice Address - Phone:608-263-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61185207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology