Provider Demographics
NPI:1588618805
Name:DURKEE, CHARLES T (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:DURKEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC UROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-3794
Mailing Address - Fax:414-266-1752
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC UROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3794
Practice Address - Fax:414-266-1752
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI20786208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
340020411OtherRAILROAD MEDICARE
006000261YOtherHUMANA
WI30359400Medicaid
1335877OtherUHC
000810342850OtherPCHS
WI1588618805Medicaid
WI30359400Medicaid
1335877OtherUHC