Provider Demographics
NPI:1629284021
Name:DROESE, KARL W (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:W
Last Name:DROESE
Suffix:
Gender:M
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:S99W24280 FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9540
Mailing Address - Country:US
Mailing Address - Phone:262-662-5318
Mailing Address - Fax:
Practice Address - Street 1:W229S9180 CLARK ST
Practice Address - Street 2:
Practice Address - City:BIG BEND
Practice Address - State:WI
Practice Address - Zip Code:53103-9528
Practice Address - Country:US
Practice Address - Phone:262-662-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48925-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34779000Medicaid
WI48925-020OtherSTATE LICENSE
WIBD9602889OtherDEA REGISTRATION