Provider Demographics
NPI:1265447783
Name:POETKER, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:POETKER
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:OTOLARYNGOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5581
Mailing Address - Fax:414-805-7890
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:OTOLARYNGOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5581
Practice Address - Fax:414-805-7890
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45046-020207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1265447783Medicaid
WI680860576Medicare PIN
WI1265447783Medicaid
WI032V73601Medicare PIN