Provider Demographics
NPI:1154523207
Name:KALENCKI, WANDA BETH (DO)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:BETH
Last Name:KALENCKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118C ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:KOHLER
Mailing Address - State:WI
Mailing Address - Zip Code:53044-1400
Mailing Address - Country:US
Mailing Address - Phone:920-803-6440
Mailing Address - Fax:
Practice Address - Street 1:1118C ASPEN CT
Practice Address - Street 2:
Practice Address - City:KOHLER
Practice Address - State:WI
Practice Address - Zip Code:53044-1400
Practice Address - Country:US
Practice Address - Phone:920-803-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.004465207L00000X
WI29873-021207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology