MEDICARE: CATHERINE ANN KISTLER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	8838-23	WI
2	363A00000X	Physician Assistant	085.008525	IL

General Provider Information

NPI Number	:	1649855974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ANN KISTLER PA-C

Provider Business Mailing Address
First Line	:	1233 N MAYFAIR RD STE 207
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1233 N MAYFAIR RD STE 207
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3255
Country	:	US
Telephone Number	:	414-285-6018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	03/20/2026

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