Provider Demographics
NPI:1205192069
Name:BREMBERGER, LAUREN K (MD)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:K
Last Name:BREMBERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:KATE
Other - Last Name:LIETZAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1500 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9317
Mailing Address - Country:US
Mailing Address - Phone:262-928-7500
Mailing Address - Fax:
Practice Address - Street 1:1500 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9317
Practice Address - Country:US
Practice Address - Phone:262-928-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400237185Medicare PIN