Provider Demographics
NPI:1780747923
Name:CASE, KERRY ANN (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:CASE
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:725 AMERICAN AVE STE 108
Mailing Address - Street 2:PHC REGIONAL CANCER CENTER
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5031
Mailing Address - Country:US
Mailing Address - Phone:262-928-2055
Mailing Address - Fax:262-928-7980
Practice Address - Street 1:725 AMERICAN AVE STE 108
Practice Address - Street 2:PHC REGIONAL CANCER CENTER
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-2055
Practice Address - Fax:262-928-7980
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI51349-20207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
683750586Medicare PIN