Provider Demographics
NPI:1811121023
Name:ROSTEING, KEVIN PETER (MD, MSMI)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:PETER
Last Name:ROSTEING
Suffix:
Gender:M
Credentials:MD, MSMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 HERITAGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4017
Mailing Address - Country:US
Mailing Address - Phone:920-347-1990
Mailing Address - Fax:920-347-1991
Practice Address - Street 1:2126 WILLIAM FRANCIS CT
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6352
Practice Address - Country:US
Practice Address - Phone:920-347-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI29168OtherWI STATE LICENCE
WIBR0875419OtherDEA
WIBR0875419OtherDEA