Individual
KATRINA K MCGILLIVRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
610 W ADAMS ST, BLACK RIVER FALLS, WI 54615
(715) 284-4311
(715) 284-0475
Mailing address
610 W ADAMS ST, BLACK RIVER FALLS, WI 54615-9010
(715) 284-4311
(715) 284-0475
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33649-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000089960
BLUE CROSS ANTHEM
IN
01
—
080119274
MEDICARE RAILROAD
IN
05
—
1000772951
—
WI
01
—
110253
SIHO
IN
01
—
2001532
IN MEDICAL LICENSE
IN
Enumeration date
05/02/2006
Last updated
06/30/2025
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