Provider Demographics
NPI:1972879989
Name:KIRCHEN, GWYNNE DEBOER (MD)
Entity type:Individual
Prefix:DR
First Name:GWYNNE
Middle Name:DEBOER
Last Name:KIRCHEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6100
Mailing Address - Fax:414-805-6147
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6100
Practice Address - Fax:414-805-6147
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI61714207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1972879989Medicaid