Provider Demographics
NPI:1215139951
Name:LIGARAY, KENNETH PATRICK L (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH PATRICK
Middle Name:L
Last Name:LIGARAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1507
Mailing Address - Country:US
Mailing Address - Phone:608-417-6000
Mailing Address - Fax:
Practice Address - Street 1:345 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2996
Practice Address - Country:US
Practice Address - Phone:608-417-8300
Practice Address - Fax:608-417-8301
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27817207RE0101X
WI64266207RE0101X
MDD70299207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
636005396005OtherHUMANA GOLD CHOICE MEDICARE
AL051559283Medicaid
AL51006036OtherBCBS
Z08404OtherVIVA AND VIVAM
P00456471Medicare PIN
636005396005OtherHUMANA GOLD CHOICE MEDICARE