Provider Demographics
NPI:1811969843
Name:REGNER, KEVIN R (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:REGNER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF NEPHROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-456-4755
Mailing Address - Fax:414-805-9050
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF NEPHROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-456-4755
Practice Address - Fax:414-805-9050
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-06-12
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Provider Licenses
StateLicense IDTaxonomies
MN44808207RN0300X
WI50061207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34775600Medicaid
WI1811969843Medicaid
MN697619100Medicaid
H65792Medicare UPIN
MN390000357Medicare ID - Type Unspecified
MN697619100Medicaid
WI34775600Medicaid