Kestrel Medical LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

KESTREL MEDICAL LLC

Practice address

888 Thackeray TRL Ste 105
Oconomowoc, WI 53066-4342

Phone

(262) 354-0764

NPI assigned

Mar 15, 2018

Last updated

Jan 19, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bruce M Johnson

Title

Owner

Phone

(262) 354-0764

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1639672744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 THACKERAY TRL STE 105",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664342",
            "telephone_number": "262-354-0764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 THACKERAY TRL STE 105",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664342",
            "telephone_number": "262-354-0764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KESTREL MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-15",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-354-0764",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Ann Keller, MPT
• Patricia R Kelley, RN
• Kelly Medical Services, S.C.
• Heidi Dawn Kenyon, RN
• Theresa M Kerner, MA, LPC
• Catherine D Keulks-Torinus, P.A.C.
• Evgeniya Khen, NP
• Ann M Kiesow, MA-CCCA
• Kyle J Kircher, M.D.
• Deborah J Klecker, LPC, MFT-IT, SAC-IT

• Prosthetic/Orthotic Supplier in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Prosthetic/Orthotic Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; 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.