Provider Demographics
NPI:1447549829
Name:BANNON, KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:BANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:DUBOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2402 WINNEBAGO ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5341
Practice Address - Country:US
Practice Address - Phone:608-242-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-137482207V00000X
WI81658-20207V00000X
IL036.137482207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology