Provider Demographics
NPI:1326032624
Name:KASTNER, KIMBERLY J (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:KASTNER
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 1:970 S SILVER LAKE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3802
Mailing Address - Country:US
Mailing Address - Phone:262-569-7100
Mailing Address - Fax:262-567-6295
Practice Address - Street 1:970 S SILVER LAKE ST STE 102
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3802
Practice Address - Country:US
Practice Address - Phone:262-569-7100
Practice Address - Fax:262-567-6295
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34623700Medicaid
WI34623700Medicaid
WII26583Medicare UPIN