Healthcare Provider Details

I. General information

NPI: 1467418335
Provider Name (Legal Business Name): KAREN S AILSWORTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TUTTLE ST
BARABOO WI
53913-3319
US

IV. Provider business mailing address

1515 ASH ST
BARABOO WI
53913-1356
US

V. Phone/Fax

Practice location:
  • Phone: 608-355-3800
  • Fax: 608-355-7001
Mailing address:
  • Phone: 608-355-1240
  • Fax: 608-355-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35472-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: