Provider Demographics
NPI:1922533074
Name:VOSS, KAITLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:VOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:GUNDRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:262-268-5100
Mailing Address - Fax:262-268-5115
Practice Address - Street 1:1475 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-2074
Practice Address - Country:US
Practice Address - Phone:262-268-5100
Practice Address - Fax:262-268-5115
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72820-20208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100103177Medicaid