Basic Information
Provider Information | |||||||||
NPI: | 1720043672 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KAISER | ||||||||
FirstName: | CATHRYN | ||||||||
MiddleName: | I | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 833 S IOWA ST | ||||||||
Address2: | STE 102 | ||||||||
City: | DODGEVILLE | ||||||||
State: | WI | ||||||||
PostalCode: | 535331900 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6089353301 | ||||||||
FaxNumber: | 6089353823 | ||||||||
Practice Location | |||||||||
Address1: | 833 S IOWA ST | ||||||||
Address2: | STE 102 | ||||||||
City: | DODGEVILLE | ||||||||
State: | WI | ||||||||
PostalCode: | 535331900 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6089353301 | ||||||||
FaxNumber: | 6089353823 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/20/2006 | ||||||||
LastUpdateDate: | 09/28/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20210-020 | WI | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 31027000 | 05 | WI |   | MEDICAID | 198 | 01 | WI | DEAN HEALTH INSURANCE | OTHER | 1000593 | 01 | WI | PHYSICIANS PLUS | OTHER |