1811997612 NPI number — LUCINDA K FENSKE M.D.

Table of content: LUCINDA K FENSKE M.D. (NPI 1811997612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811997612 NPI number — LUCINDA K FENSKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FENSKE
Provider First Name:
LUCINDA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1811997612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8615 N DEAN CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER HILLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-352-8071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 N LAKE DR
Provider Second Line Business Practice Location Address:
SUITE 502
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53211-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-271-3300
Provider Business Practice Location Address Fax Number:
414-271-5549
Provider Enumeration Date:
07/22/2005

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: 207V00000X , with the licence number:  27618 , 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: 0004101092 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0603214061727 . This is a "INDEPENDENT CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31504100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160058538 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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