Healthcare Provider Details

I. General information

NPI: 1700852795
Provider Name (Legal Business Name): KIM M KANTOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 EAST TOWNE BLVD
MADISON WI
53704
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-242-6855
  • Fax: 608-242-6848
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32217
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: