Provider Demographics
NPI:1790954063
Name:TALERICO, KATHRYN VERONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:VERONICA
Last Name:TALERICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:752 N HIGH POINT RD
Mailing Address - Street 2:DEAN CLINIC
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2236
Mailing Address - Country:US
Mailing Address - Phone:608-824-4000
Mailing Address - Fax:608-824-4910
Practice Address - Street 1:752 N HIGH POINT RD
Practice Address - Street 2:DEAN CLINIC
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2236
Practice Address - Country:US
Practice Address - Phone:608-824-4000
Practice Address - Fax:608-824-4910
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI52891-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61081OtherDEAN HEALTH INSURANCE
WI741501798Medicare PIN