Provider Demographics
NPI:1083063648
Name:BASSE, ERIKA J (PAC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:J
Last Name:BASSE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:J
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF ORTHOPAEDIC SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-3666
Mailing Address - Fax:414-805-7499
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:ORTHOPAEDIC SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-805-3666
Practice Address - Fax:414-805-7499
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1083063648Medicaid
WIK400325022Medicare PIN