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General NPI Number Information
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NPI Number | 1053674770
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Entity Type | Individual
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Provider Name | KATHRYN R TRANDEM MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 205 PARKER ST
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City | BOSCOBEL
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State | WI
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Zip | 53805-1642
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Country | US
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Telephone | 608-375-4112
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-3794
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Fax | 414-266-1752
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 036.154905
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 73669
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 73669
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License Number State | WI
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