Provider Demographics
NPI:1629064035
Name:MAUKS, KATHLEEN S (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:S
Last Name:MAUKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:57 NORTH ST
Mailing Address - Street 2:SUITE # 311
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5660
Mailing Address - Country:US
Mailing Address - Phone:203-743-0100
Mailing Address - Fax:203-794-1851
Practice Address - Street 1:57 NORTH ST
Practice Address - Street 2:SUITE # 311
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5660
Practice Address - Country:US
Practice Address - Phone:203-743-0100
Practice Address - Fax:203-794-1851
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT014605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010014605CT01OtherBC/BS
CT001146059Medicaid
CT040045OtherHEALTHNET
CT0078385OtherUNITED HEALTH CARE
CTP476668OtherOXFORD
CT4283743OtherAETNA
CT714605OtherCONNECTICARE
CT040045OtherHEALTHNET
110000610Medicare PIN