Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 038-010349 | IL |
Y | 111NN0400X | Neurology | 4264-12 | WI |
NPI | 1285703710 |
---|---|
Provider Name | Dr. Kelly G. Von-Schilling Worth |
First Address | Racine, WI 53404-7008 |
Second Address | Mount Pleasant, WI 53406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 15/06/2018 |