Provider Demographics
NPI:1578901427
Name:BARTZ-KURYCKI, MARISA ANGELINE (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ANGELINE
Last Name:BARTZ-KURYCKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:ANGELINE
Other - Last Name:BARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-1400
Mailing Address - Fax:414-955-0197
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-1400
Practice Address - Fax:414-955-0197
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75146208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1578901427Medicaid
TXQ9122OtherTEXAS MEDICAL BOARD
AZ60878OtherARIZONA MEDICAL BOARD