Provider Demographics
NPI:1639196611
Name:PROWATZKE, SHERRY L (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:PROWATZKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 N CALHOUN RD
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5003
Mailing Address - Country:US
Mailing Address - Phone:262-928-7100
Mailing Address - Fax:262-513-7111
Practice Address - Street 1:2085 N CALHOUN RD
Practice Address - Street 2:2085 N CALHOUN RD
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5003
Practice Address - Country:US
Practice Address - Phone:262-928-7100
Practice Address - Fax:262-513-7111
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31478207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
68375Medicare PIN
WIE46134Medicare UPIN