Healthcare Provider Details

I. General information

NPI: 1518540657
Provider Name (Legal Business Name): CAITLIN VICTORIA MARY FLEMING MD/MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN VICTORIA MARY FLEMING

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MCMILLEN ST
FORT ATKINSON WI
53538-1233
US

IV. Provider business mailing address

500 MCMILLEN ST
FORT ATKINSON WI
53538-1233
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-5666
  • Fax: 713-500-5800
Mailing address:
  • Phone: 713-500-5666
  • Fax: 713-500-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8401720
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: