Provider Demographics
NPI:1386729093
Name:KANE, KAREN LIM (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LIM
Last Name:KANE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:G
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5534 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1298
Mailing Address - Country:US
Mailing Address - Phone:608-274-0355
Mailing Address - Fax:
Practice Address - Street 1:5534 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1298
Practice Address - Country:US
Practice Address - Phone:608-274-0355
Practice Address - Fax:608-274-5546
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2921-57103T00000X
IL0710066332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2921-57OtherWI LICENSE