Provider Demographics
NPI:1265496319
Name:DOENIER, TODD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:DOENIER
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 1:1111 DELAFIELD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3407
Mailing Address - Country:US
Mailing Address - Phone:262-446-0955
Mailing Address - Fax:262-446-0055
Practice Address - Street 1:1111 DELAFIELD ST STE 300
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3407
Practice Address - Country:US
Practice Address - Phone:262-446-0955
Practice Address - Fax:262-446-0055
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1265496319Medicaid
WI1508046517Medicaid