Provider Demographics
NPI:1235123712
Name:STULA, GOJKO D (MD)
Entity Type:Individual
Prefix:
First Name:GOJKO
Middle Name:D
Last Name:STULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3238 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4535
Mailing Address - Country:US
Mailing Address - Phone:414-643-4430
Mailing Address - Fax:414-643-4693
Practice Address - Street 1:3238 S 16TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4535
Practice Address - Country:US
Practice Address - Phone:414-643-4430
Practice Address - Fax:414-643-4693
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32729500Medicaid
WI32729500Medicaid
WI0026-02475Medicare ID - Type Unspecified