Provider Demographics
NPI:1093972754
Name:PAGE, TRACY LOUISE (MD,MA)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LOUISE
Last Name:PAGE
Suffix:
Gender:F
Credentials:MD,MA
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:LOUISE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,MA
Mailing Address - Street 1:2801 E ENTERPRISE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8559
Mailing Address - Country:US
Mailing Address - Phone:920-968-9311
Mailing Address - Fax:920-305-7411
Practice Address - Street 1:2801 E ENTERPRISE AVE STE 205
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8559
Practice Address - Country:US
Practice Address - Phone:920-968-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ408522081P2900X, 2081S0010X
WI64564-202083B0002X, 2083P0901X, 208100000X, 2083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine