Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Keith Dallenbach Jr., RN, ACNPC-AG

Individual provider Acute Care Nurse Practitioner · NPI 1104202506

Keith Dallenbach Jr., RN, ACNPC-AG is a Nurse Practitioner in Milwaukee, Wisconsin. Qualified in 2015, 11 years ago. Practices with The Medical College of Wisconsin Inc, a 2,093-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
11
Licensed in
WI
In the registry since
2015
What do these letters mean?
RN — Registered Nurse
A licensed nurse who completed a nursing degree and passed the NCLEX-RN examination.

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Practice location Address checks out

9200 W Wisconsin Ave Infectious Diseases
Milwaukee, WI 53226-3522
Phone: (414) 805-0746
Fax: (414) 805-0748
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 179816 (WI)

Record details

NPI number1104202506
Entity typeIndividual (Type 1)
GenderMale
Credentials RN , ACNPC-AG
Sole proprietorNo
NPI enumeratedAugust 7, 2015
Last updated in NPPESAugust 14, 2015

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice The Medical College Of Wisconsin Inc — 2093 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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