Provider Demographics
NPI:1700922754
Name:KALDOR, KATHERYN R (DO)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:R
Last Name:KALDOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6800
Mailing Address - Fax:608-756-6164
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6800
Practice Address - Fax:608-756-6164
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07959600207V00000X
WI57274-21207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700922754OtherBCBSWI
WIKALDOKATOtherMERCYCARE INSURANCE
IL512744322 1Medicaid
WI1700922754Medicaid
NJ036546Medicare Oscar/Certification
IL512744322 1Medicaid
WI541760890Medicare PIN