Provider Demographics
NPI:1992055925
Name:PERKINS, KENT L
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:L
Last Name:PERKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 N 89TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1759
Mailing Address - Country:US
Mailing Address - Phone:414-510-9246
Mailing Address - Fax:414-939-7110
Practice Address - Street 1:4262 N 89TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1759
Practice Address - Country:US
Practice Address - Phone:414-510-9246
Practice Address - Fax:414-939-7110
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI146L00000X146L00000X
WI37-1659913343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992055925Medicaid
WI1992055925Medicare Oscar/Certification
WI1992055925Medicare NSC
WI1992055925Medicaid
WI1992055925Medicare PIN