| Doctor Name: | DR. KEVIN L MORTARA |
| NPI Number: | 1033109210 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 48997-20 |
| Business Practice Address: | 1580 Commanche Ave Green Bay, WI - 543135751 |
| Business Phone Number: | 9204358326 |
| Business Fax Number: | 9204304659 |
| Mailing Address: | 1580 Commanche Ave, GREEN BAY |
| State: | WI |
| Postal Code: | 543135751 |
| Phone Number: | 9204358326 |
| Fax Number: | 9204304659 |
| NPI Enumeration Date: | 10/27/2005 |
| NPI Last Update Date: | 06/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RH0003X |
| License Number: | 48997-20 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Hematology & Oncology |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |