Kidney Institute of Wisconsin, LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

KIDNEY INSTITUTE OF WISCONSIN, LLC

Practice address

5650 N Green Bay Ave
Suite 150
Glendale, WI 53209-4446

Phone

(414) 431-5960

Fax

(414) 434-0359

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Herbert S Lawson

Title

Cfo

Phone

(303) 785-7521

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831262674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 CENTRAL AVE",
            "address_2": "SUITE 201",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012838",
            "telephone_number": "303-785-7523",
            "fax_number": "303-444-8639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5650 N GREEN BAY AVE",
            "address_2": "SUITE 150",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532094446",
            "telephone_number": "414-431-5960",
            "fax_number": "414-434-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY INSTITUTE OF WISCONSIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAWSON",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-785-7521"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42059400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Rae Keil, APSW
• Janelle Keller, LPC-IT
• Juwania Keys
• Melanie Dawn Keys
• Talal R Khairi, MD
• Paula M Kiehl, APNP
• Byung Geun Kim, APN
• Kindred
• Rebecca Ann King, COTA, CKTP, CLT
• Kyle Kirst, OTR

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Glendale, WI
• Providers in Glendale, WI by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.