Individual
MR. KIM J PANSEGRAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
7007 OLD SAUK RD, MADISON, WI 53717-2307
(608) 833-2060
(608) 833-1737
Mailing address
3296 SARACEN WAY, VERONA, WI 53593-8010
(608) 821-0289
(608) 833-1787
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5144015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33755700
—
WI
Enumeration date
07/08/2006
Last updated
07/08/2007
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