Provider Demographics
NPI:1346230612
Name:BRATANOW, NANCY C (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:BRATANOW
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 1:2500 N MAYFAIR RD STE 480
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1443
Mailing Address - Country:US
Mailing Address - Phone:414-771-7400
Mailing Address - Fax:414-771-4992
Practice Address - Street 1:2500 N MAYFAIR RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-771-7400
Practice Address - Fax:414-771-4992
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24789-020208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB51718Medicare UPIN
WI000073110 SEQ:0001Medicare PIN