Provider Demographics
NPI:1639143522
Name:DEUTSCH, JERROLD M (MD)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:M
Last Name:DEUTSCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-542-2536
Mailing Address - Fax:262-542-2791
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 115
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-542-2536
Practice Address - Fax:262-542-2791
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI252382080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30824100Medicaid
WI30824100Medicaid