Provider Demographics
NPI:1477631901
Name:STAR-ADAMCZYK, URSULA (MD)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:STAR-ADAMCZYK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:HELEN
Other - Last Name:STAR-ADAMCZYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8905 W LINCOLN AVE STE 515
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2470
Mailing Address - Country:US
Mailing Address - Phone:414-328-8620
Mailing Address - Fax:414-328-8660
Practice Address - Street 1:8905 W LINCOLN AVE STE 515
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227
Practice Address - Country:US
Practice Address - Phone:414-328-8620
Practice Address - Fax:414-328-8660
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36063545207V00000X
WI47041-20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI02120-0173Medicare PIN