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Contact Information

KELLI K PETTIT, MD
1111 DELAFIELD ST,
STE 209
WAUKESHA, WI53188-3403
 Phone: 262-542-0444
 Fax: 262-542-8214
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery

208600000X 02 Physician/General Surgery
 

Surgical Oncology

2086X0206X 02 Physician/General Surgery
 

Vascular Surgery

2086S0129X 76 Physician/Peripheral Vascular Disease
Indicates primary specialty

NPI Profile & details for KELLI K PETTIT · (Female)

NPI Number 1477643807
Status Active
Credentials MD
Entity Individual
Enumeration date 10/14/2006
Last updated 04/24/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 48072-020
  • WI Medicaid 1477643807
Hospital affiliation(s)
  • OCONOMOWOC MEMORIAL HSPTL - (Acute Care)
    791 E SUMMIT AVE
    OCONOMOWOC, WI 53066
  • WAUKESHA MEMORIAL HOSPITAL - (Acute Care)
    725 AMERICAN AVE
    WAUKESHA, WI 53188
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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