Individual
KATHRYN DENISE GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
55450
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100015246
—
WI
01
—
P01024057
RR MEDICARE
WI
Enumeration date
11/10/2005
Last updated
10/02/2023
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