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NPI Code Detail

MEDICARE: DR. KATHLEEN ANN MCDOUGAL MD

MEDICARE: DR. KATHLEEN ANN MCDOUGAL MD
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
1207R00000XInternal Medicine PhysicianG81817CA
2207R00000XInternal Medicine Physician64218-20WI

General Provider Information

NPI Number : 1780671792
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHLEEN ANN MCDOUGAL MD
Provider Business Mailing Address
First Line : PO BOX 19070
Second Line :
City : GREEN BAY
State : WI
Zip : 54307-9070
Country : US
Telephone Number : 920-496-4700
Fax Number :
Provider Business Practice Location Address
First Line : 3021 VOYAGER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8303
Country : US
Telephone Number : 920-496-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 11/13/2015

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Directions to “ DR. KATHLEEN ANN MCDOUGAL MD” Practice Location

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