Provider Demographics
NPI:1417991084
Name:BERESKY, RONALD E (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:BERESKY
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 1:225 CHURCH ST
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1801
Mailing Address - Country:US
Mailing Address - Phone:608-877-2700
Mailing Address - Fax:608-877-2726
Practice Address - Street 1:225 CHURCH ST
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1801
Practice Address - Country:US
Practice Address - Phone:608-877-2700
Practice Address - Fax:608-877-2726
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30185-020208600000X
WAMD60287580208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31494700Medicaid
WI1760OtherDEAN HEALTH INSURANCE
WI1760OtherDEAN HEALTH INSURANCE
E53286Medicare UPIN
WI022554340Medicare PIN
WI020574150Medicare PIN