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

Kenneth B. Gordon, MD

Individual provider Dermatology Physician · NPI 1790865806

Kenneth B. Gordon, MD is a Dermatology in Wauwatosa, Wisconsin. Graduated from Columbia University College of Physicians and Surgeons in 1990, 36 years ago. Practices with The Medical College of Wisconsin Inc, a 2,093-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois and Wisconsin.

Years since qualifying
36
Trained at
Columbia University College of Physicians and Surgeons
Licensed in
IL, WI
In the registry since
2006
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

10000 W Bluemound Rd
Wauwatosa, WI 53226-4321
Phone: (414) 454-8000
Fax: (414) 805-3888
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 — (414) 805-3666

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence 66663 (WI)
Dermatology Physician Taxonomy 207N00000X · Licence 036086146 (IL)

Record details

NPI number1790865806
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedOctober 16, 2006
Last updated in NPPESJuly 26, 2022
Certification dateJuly 26, 2022

Medicare enrollment

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

Medicare specialtyDERMATOLOGY
Medical schoolCOLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS
Graduated 1990 (36 years in practice)
Group practice The Medical College Of Wisconsin Inc — 2093 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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