| Keven R Mottinger, PAC | |
|
3400 Market Ln, Kenosha, WI 53144-3430 | |
| (262) 551-4600 | |
| (262) 551-4630 |
| Full Name | Keven R Mottinger |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 3400 Market Ln, Kenosha, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154377091 | NPI | - | NPPES |
| 12006222 | Other | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 1868 (Wisconsin) | Primary |
| Entity Name | Froedtert South Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1558305284 PECOS PAC ID: 9537071196 Enrollment ID: O20031103000493 |
| Mailing Address | Practice Location Address |
|---|---|
| Keven R Mottinger, PAC 4536 22nd Ave, Kenosha, WI 53140-5917 Ph: (262) 656-0044 | Keven R Mottinger, PAC 3400 Market Ln, Kenosha, WI 53144-3430 Ph: (262) 551-4600 |
David B Kite, PA Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 10400 75th St, Kenosha, WI 53142 Phone: 262-948-7000 |
William T Merritt, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 6121 Green Bay Rd Ste 100, Kenosha, WI 53142 Phone: 262-945-7557 Fax: 262-727-0841 |
Inna Ialama, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 6811 118th Ave, Kenosha, WI 53142 Phone: 262-857-5750 |
Miss Sarah Rens, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 6308 8th Ave, Kenosha, WI 53143 Phone: 262-656-3590 Fax: 262-656-3591 |
Alison M Ketterhagen, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 10400 75th St, Kenosha, WI 53142 Phone: 262-948-5600 |
Elizabeth Bisciglia, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 7540 22nd Ave, Kenosha, WI 53143 Phone: 262-656-7800 Fax: 262-656-6957 |
Mr. William Henry Price, RSA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 4819 5th Ave, Unit 2, Kenosha, WI 53140 Phone: 847-917-3666 Fax: 888-370-3138 |