Provider Demographics
NPI:1467418335
Name:AILSWORTH, KAREN S (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:AILSWORTH
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 1:1515 ASH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1356
Mailing Address - Country:US
Mailing Address - Phone:608-355-1240
Mailing Address - Fax:608-355-9643
Practice Address - Street 1:1700 TUTTLE ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-3319
Practice Address - Country:US
Practice Address - Phone:608-355-3800
Practice Address - Fax:608-355-7001
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35472-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32039800Medicaid
WI1000147OtherPHYSICIANS PLUS
WI4275OtherDEAN HEALTH INSURANCE
WI370020214Medicare PIN
WI1000147OtherPHYSICIANS PLUS
WI32039800Medicaid
F84611Medicare UPIN