Provider Demographics
NPI:1154491298
Name:STANGER, ANN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:STANGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2984 TRIVERTON PIKE DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5841
Mailing Address - Country:US
Mailing Address - Phone:608-233-2378
Mailing Address - Fax:608-233-2375
Practice Address - Street 1:2984 TRIVERTON PIKE DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5841
Practice Address - Country:US
Practice Address - Phone:608-233-2378
Practice Address - Fax:608-233-2375
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31332208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI15007Medicare ID - Type Unspecified
F04498Medicare UPIN