Basic Information
| Provider Information | |||||||||
| NPI: | 1053379586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRIGAN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 E LA CROSSE ST | ||||||||
| Address2: | JUNEAU COUNTY HUMAN SERVICES | ||||||||
| City: | MAUSTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539482101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088472400 | ||||||||
| FaxNumber: | 6088479599 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 E LA CROSSE ST | ||||||||
| Address2: | JUNEAU COUNTY HUMAN SERVICES | ||||||||
| City: | MAUSTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539482101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088472400 | ||||||||
| FaxNumber: | 6088479599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 08/06/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 37438020 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 22545500 | 05 | WI | MEDICAID |