Provider Demographics
NPI:1518951136
Name:CORAN, JUDITH BECKER (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:BECKER
Last Name:CORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:B
Other - Last Name:CORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3033 W LAYTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2628
Mailing Address - Country:US
Mailing Address - Phone:414-279-5579
Mailing Address - Fax:414-249-3299
Practice Address - Street 1:3033 W LAYTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2628
Practice Address - Country:US
Practice Address - Phone:414-279-5579
Practice Address - Fax:414-249-3299
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38690207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32312600Medicaid
WIP00243185OtherPALMETTO GBA-RAILROAD
WIF66766Medicare UPIN
WI32312600Medicaid
WI000301372Medicare PIN