Provider Demographics
NPI:1447247598
Name:KAUTH, LAURENCE CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:CHARLES
Last Name:KAUTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3213 N CRAMER ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3030
Mailing Address - Country:US
Mailing Address - Phone:414-962-2522
Mailing Address - Fax:414-962-2522
Practice Address - Street 1:229 E WISCONSIN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4212
Practice Address - Country:US
Practice Address - Phone:414-224-3737
Practice Address - Fax:414-224-3725
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16810-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI118941-1Medicare ID - Type Unspecified
WIF21785Medicare UPIN