Healthcare Provider Details

I. General information

NPI: 1285600205
Provider Name (Legal Business Name): CATHERINE KELLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 MONROE ST
MADISON WI
53711-2016
US

IV. Provider business mailing address

1802 MONROE ST
MADISON WI
53711-2016
US

V. Phone/Fax

Practice location:
  • Phone: 84-691-8106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28774
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: