Provider Demographics
NPI:1033152657
Name:STURTZ, ADAM (PA-C)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:STURTZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 W KILBOURN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1330
Mailing Address - Country:US
Mailing Address - Phone:414-276-6000
Mailing Address - Fax:414-276-1758
Practice Address - Street 1:1218 W KILBOURN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1330
Practice Address - Country:US
Practice Address - Phone:414-276-6000
Practice Address - Fax:414-276-1758
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1849-203363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42870800Medicaid
WIQ49696Medicare UPIN
WI0016-02672Medicare ID - Type UnspecifiedMILWAUKEE COUNTY
WI0758920001Medicare NSC
WI42870800Medicaid