Individual
KELLY ANN CAROTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
40256
WI
207Q00000X
Family Medicine Physician
40256
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32474400
—
WI
Enumeration date
03/29/2007
Last updated
05/27/2021
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