Provider Demographics
NPI:1073593455
Name:ROELKE, DAVID MORGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MORGAN
Last Name:ROELKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 N EVERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-8636
Mailing Address - Country:US
Mailing Address - Phone:262-367-6722
Mailing Address - Fax:414-422-9620
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-2400
Practice Address - Fax:262-928-7621
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48771-0202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31469500Medicaid
WI003368339Medicare ID - Type Unspecified
WIW23988Medicare UPIN
WI31469500Medicaid