Provider Demographics
NPI:1972574168
Name:MCQUEEN, KATHRYN ANN KELLY (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN ANN
Middle Name:KELLY
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0028
Practice Address - Country:US
Practice Address - Phone:608-263-8100
Practice Address - Fax:615-936-6493
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21290207L00000X
TNMD48697207L00000X
WI71988-20207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ358326Medicaid
050060902OtherMEDICARE RAILROAD
AZ358326Medicaid
050060902OtherMEDICARE RAILROAD