Provider Demographics
NPI:1497033682
Name:BARTZ, KATHERINE D (PAC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:BARTZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:D
Other - Last Name:SPRUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF NEOPLASTIC DISEASES
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-4600
Mailing Address - Fax:414-805-6805
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF NEOPLASTIC DISEASES
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-4600
Practice Address - Fax:414-805-6805
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2767363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1497033682Medicaid
WI736012241Medicare PIN
WI1497033682Medicaid