Provider Demographics
NPI:1578779914
Name:DANA R. TROTTER MD SC
Entity Type:Organization
Organization Name:DANA R. TROTTER MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-637-1000
Mailing Address - Street 1:5439 DURAND AVE
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5058
Mailing Address - Country:US
Mailing Address - Phone:262-637-1000
Mailing Address - Fax:
Practice Address - Street 1:5439 DURAND AVE
Practice Address - Street 2:#103
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5058
Practice Address - Country:US
Practice Address - Phone:262-637-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31440800Medicaid
52135Medicare ID - Type Unspecified