Provider Demographics
NPI:1568542975
Name:MULCAHEY, KATHRYN
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MULCAHEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 OLYMPIA FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1277
Mailing Address - Country:US
Mailing Address - Phone:262-628-6969
Mailing Address - Fax:414-414-4033
Practice Address - Street 1:1289 OLYMPIA FIELDS DR
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-1277
Practice Address - Country:US
Practice Address - Phone:262-628-6969
Practice Address - Fax:414-414-4033
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092871Medicaid
IL809840Medicare ID - Type UnspecifiedGROUP #
ILK18482Medicare ID - Type UnspecifiedINDIVIDUAL #
ILP00236243 / CA4079Medicare ID - Type UnspecifiedRR