Basic Information
| Provider Information | |||||||||
| NPI: | 1063480291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUS | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5561 KUPFER RD | ||||||||
| Address2: | |||||||||
| City: | WAUNAKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535979048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088295485 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5561 KUPFER RD # 5 | ||||||||
| Address2: | |||||||||
| City: | WAUNAKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535979048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085753194 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 28652 | WI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.