Healthcare Provider Details

I. General information

NPI: 1407187818
Provider Name (Legal Business Name): AMY KURTH CAULUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LYNN KURTH

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 JUNCTION RD
MADISON WI
53717-2656
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-890-5500
  • Fax: 608-265-0977
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1467-029
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: