Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kaukauna Clinic, SC

Organization Family Medicine Physician · NPI 1457317273

Kaukauna Clinic, SC is a Family Medicine Physician in Kaukauna, Wisconsin. Registered with an NPI since 2006.

In the registry since
2006

Practice location Address checks out

305 E 12th St
Kaukauna, WI 54130-2865
Phone: (920) 766-4656
Fax: (920) 766-4659
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1457317273
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Paul Russo — President · (920) 766-4656
NPI enumeratedApril 21, 2006
Last updated in NPPESNovember 13, 2025
Certification dateNovember 13, 2025
Mailing address305 E 12th St, Kaukauna, WI 54130-2865

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