Provider Demographics
NPI:1689887010
Name:GAERTNER, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:GAERTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3930 S LAKE DR
Mailing Address - Street 2:UNIT 501
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53235-5238
Mailing Address - Country:US
Mailing Address - Phone:414-483-2808
Mailing Address - Fax:414-747-8874
Practice Address - Street 1:3930 S LAKE DR
Practice Address - Street 2:UNIT 501
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53235-5238
Practice Address - Country:US
Practice Address - Phone:414-483-2808
Practice Address - Fax:414-747-8874
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI23319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1352952Medicare UPIN