Individual
COLIN DAVID KAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1121 BELLWEST BLVD, BELLEVILLE, WI 53508-9433
(608) 424-3384
(608) 424-6353
Mailing address
1121 BELLWEST BLVD, BELLEVILLE, WI 53508-9433
(608) 424-3384
(608) 424-6353
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
77586
WI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/16/2021
Last updated
03/15/2023
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