Provider Demographics
NPI:1265489314
Name:KURTZ, ROBERTA G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:G
Last Name:KURTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S PARK ST
Mailing Address - Street 2:ST MARYS HOSPITAL DEAN MEDICAL CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1849
Mailing Address - Country:US
Mailing Address - Phone:608-258-5020
Mailing Address - Fax:608-258-5076
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:ST MARYS HOSPITAL DEAN MEDICAL CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1849
Practice Address - Country:US
Practice Address - Phone:608-258-5020
Practice Address - Fax:608-258-5076
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44971-020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60132OtherDEAN HEALTH INSURANCE
WI34295700Medicaid
WI60132OtherDEAN HEALTH INSURANCE
WI34295700Medicaid
WI032413080Medicare PIN
A76138Medicare UPIN
WI081874150Medicare PIN
WI031554340Medicare PIN