Provider Demographics
NPI:1568523330
Name:O'ROURKE, COLLEEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:J
Last Name:O'ROURKE
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 1:421 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-2225
Mailing Address - Country:US
Mailing Address - Phone:920-746-7155
Mailing Address - Fax:920-746-2439
Practice Address - Street 1:421 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2225
Practice Address - Country:US
Practice Address - Phone:920-746-7155
Practice Address - Fax:920-746-2439
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26694-202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIOROURCOL-MOOtherMERCYCARE INSURANCE
WI1568523330OtherDEANHEALTH PLAN
WI1568523330OtherBCBSWI
WI30669800Medicaid
WI1568523330Medicaid
WI1568523330Medicaid
WI1568523330OtherDEANHEALTH PLAN
WI541760374Medicare PIN
IL$$$$$$$$$ 1Medicaid