Provider Demographics
NPI:1790216554
Name:HIGHLANDER DERMATOLOGY LLC
Entity Type:Organization
Organization Name:HIGHLANDER DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:TJ
Authorized Official - Last Name:STRAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-899-2385
Mailing Address - Street 1:2607 N GRANDVIEW BLVD
Mailing Address - Street 2:STE 125
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1686
Mailing Address - Country:US
Mailing Address - Phone:262-290-4540
Mailing Address - Fax:262-229-2220
Practice Address - Street 1:2607 N GRANDVIEW BLVD
Practice Address - Street 2:STE 125
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1686
Practice Address - Country:US
Practice Address - Phone:414-455-0919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIH059290261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326031964OtherSOLE OWNER NPI: 1326031964. HIGHLANDER LLC TIN: