Garrison, Kenneth Joe

Garrison, Kenneth Joe is an individual health care provider with primary practice located at 105 4Th Ave , Shell Lake WI 54871-0189. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Garrison, Kenneth Joe can be contacted via phone (715) 468-2711.

Contact Information

Primary practice address
105 4Th Ave Shell Lake WI 54871-0189
Phone: (715) 468-2711
Fax: (715) 468-2727
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 45490 Wisconsin

Profile Details

NPI number 1316945512
LBN Legal business name Garrison, Kenneth Joe
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316945512 NPPES
Wisconsin MEDICAID 34380700
Wisconsin Other 266R9GA

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