Provider Demographics
NPI:1699797225
Name:GRAUPNER, KENNETH C (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:GRAUPNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 FRONT STREET
Mailing Address - Street 2:STE 3D
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1667
Mailing Address - Country:US
Mailing Address - Phone:920-885-2780
Mailing Address - Fax:920-885-2788
Practice Address - Street 1:200 FRONT STREET
Practice Address - Street 2:STE 3D
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1667
Practice Address - Country:US
Practice Address - Phone:920-885-2780
Practice Address - Fax:920-885-2788
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI170950202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31056900Medicaid
WI31056900Medicaid
750Medicare UPIN