Provider Demographics
NPI:1073567939
Name:MAURER, ADRIENNE M (MD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:M
Last Name:MAURER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:M
Other - Last Name:GOEDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:N112W17975 MEQUON RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-2425
Mailing Address - Country:US
Mailing Address - Phone:262-532-7600
Mailing Address - Fax:
Practice Address - Street 1:N112W17975 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022
Practice Address - Country:US
Practice Address - Phone:262-532-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34848700Medicaid
WI34848700Medicaid