Kenneth Gordon Kalinowski, APNP
Individual provider Active NPI Nurse Practitioner · Prairie Du Sac, WI
NPI 1174580468 · NPPES record last updated Nov 20, 2017
Key facts
- NPI
- 1174580468
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 7939 (WI)
- Practice address
- 250 26TH St Ste 130
Prairie Du Sac, WI 53578-2205 - Phone
- (414) 325-7246
- Fax
- (414) 325-3770
- NPI assigned
- Apr 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125666030 | WI | MD | Registered Nurse |
| 7939 | WI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Floyd County Memorial Hospital Commission | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 7939 | WI | Yes |
| Registered Nurse | 163W00000X | 125666030 | WI |
Addresses
Primary practice location
250 26TH St Ste 130
Prairie Du Sac, WI 53578-2205
Mailing address
4131 W Loomis Rd Ste 300
Greenfield, WI 53221-2059
Phone (414) 325-7246
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39968700 | Medicaid | WI |
Other providers in Prairie Du Sac, WI
- Jay P Ironside
- Lisa A Jansen
- Colleen L Jarema
- Curtis N Johnson
- Mary E Johnson
- Christina L Karg
- Julie A Kastelitz
- Bryant Randall Kearney
- Holly J Kindschi
- Lori E King
All providers in Prairie Du Sac, WI · Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.