Provider Demographics
NPI:1073746517
Name:KATHY D HARTKE MD SC
Entity Type:Organization
Organization Name:KATHY D HARTKE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-798-1910
Mailing Address - Street 1:20611 WATERTOWN RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1871
Mailing Address - Country:US
Mailing Address - Phone:262-798-1910
Mailing Address - Fax:262-798-8660
Practice Address - Street 1:20611 WATERTOWN RD
Practice Address - Street 2:SUITE E
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-798-1910
Practice Address - Fax:262-798-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31374100Medicaid
WIB56962Medicare UPIN
WI31374100Medicaid