Provider Demographics
NPI:1003930843
Name:KARTHEISER, EDWARD (MA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:KARTHEISER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2121
Mailing Address - Country:US
Mailing Address - Phone:414-963-0570
Mailing Address - Fax:
Practice Address - Street 1:5800 N. BAYSHORE DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-962-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1212-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40983700Medicaid