1265498281 NPI number — R. R. FLICKINGER JR. M.D.

Table of content: R. R. FLICKINGER JR. M.D. (NPI 1265498281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265498281 NPI number — R. R. FLICKINGER JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLICKINGER
Provider First Name:
R.
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265498281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 DELAFIELD ST
Provider Second Line Business Mailing Address:
SUITE 312
Provider Business Mailing Address City Name:
WAUKESHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53188-3417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-547-3352
Provider Business Mailing Address Fax Number:
262-547-9142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 DELAFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-547-3352
Provider Business Practice Location Address Fax Number:
262-547-9142
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  17452-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31224700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4016118 . This is a "AETNA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 747042 . This is a "MOHAWK" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 31224700 . This is a "MANAGED HEALTH SERVICES" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 822601 . This is a "VIPA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 09235 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 31224700 . This is a "ABRI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0800073 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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