Provider Demographics
NPI:1811936701
Name:KEPPEL, CHRISTINA C (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:C
Last Name:KEPPEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 W GLEN OAKS LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3371
Mailing Address - Country:US
Mailing Address - Phone:262-241-3698
Mailing Address - Fax:
Practice Address - Street 1:1017 W GLEN OAKS LN
Practice Address - Street 2:SUITE 201
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3371
Practice Address - Country:US
Practice Address - Phone:262-241-3698
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23798-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30415700Medicaid
B54094Medicare UPIN