Basic Information
Provider Information
NPI: 1144676727
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWNING
FirstName: KEELY
MiddleName: BORNOR
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8701 W WATERTOWN PLANK RD
Address2:  
City: WAUWATOSA
State: WI
PostalCode: 532263548
CountryCode: US
TelephoneNumber: 4149554575
FaxNumber: 4149556409
Practice Location
Address1: 8701 W WATERTOWN PLANK RD
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532263548
CountryCode: US
TelephoneNumber: 4149554575
FaxNumber: 4149556409
Other Information
ProviderEnumerationDate: 05/12/2016
LastUpdateDate: 04/07/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/07/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X71014-20WIY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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