Provider Demographics
NPI:1144214057
Name:EMAUS, ERIK A (DO)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:A
Last Name:EMAUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 MIDWAY PL
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1165
Mailing Address - Country:US
Mailing Address - Phone:920-720-1781
Mailing Address - Fax:920-720-1790
Practice Address - Street 1:411 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2753
Practice Address - Country:US
Practice Address - Phone:920-720-1781
Practice Address - Fax:920-720-1790
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40823207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30090700Medicaid
WI002145300Medicare PIN
WI032171018Medicare PIN
E90507Medicare UPIN