Healthcare Provider Details

I. General information

NPI: 1437193810
Provider Name (Legal Business Name): KEVIN A KURTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S MILLS ST DEPT. OF PATHOLOGY
MADISON WI
53715-1849
US

IV. Provider business mailing address

707 S MILLS ST DEPT. OF PATHOLOGY
MADISON WI
53715-1849
US

V. Phone/Fax

Practice location:
  • Phone: 608-258-6154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number47610-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number47610-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: