Kristen Vaccaro, DO

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

100231 Issued in WI

Practice address

8701 Watertown Plank Rd
Milwaukee, WI 53226-3548

Phone

(414) 955-1925

NPI assigned

Mar 23, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687824000000",
    "number": "1154070282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 FOREST GATE CIR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605232129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8701 WATERTOWN PLANK RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263548",
            "telephone_number": "414-955-1925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VACCARO",
        "first_name": "KRISTEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-23",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WI",
            "license": "100231",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125.079357",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN MEDICAL EXAMINING BOARD RESIDENT EDUCATION LICENSE",
            "identifier": "100231-851",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION",
            "identifier": "125.079357",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Student in an Organized Health Care Education/Training Program in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.