Individual
KHA LOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1102 S PARK ST, MADISON, WI 53715-1708
(608) 263-3111
(608) 263-3111
Mailing address
1100 DELAPLAINE CT, MADISON, WI 53715-1840
(608) 263-4550
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
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