Provider Demographics
NPI:1821063736
Name:HALANSKI, AMY DENISE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DENISE
Last Name:HALANSKI
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 1:4328 DEER RUN CT
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:WI
Mailing Address - Zip Code:53528-9309
Mailing Address - Country:US
Mailing Address - Phone:608-516-7080
Mailing Address - Fax:
Practice Address - Street 1:4328 DEER RUN CT
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:WI
Practice Address - Zip Code:53528
Practice Address - Country:US
Practice Address - Phone:608-516-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC133581208000000X
MA261526208000000X
TXQ8068208000000X
NY276783208000000X
PAMD453091208000000X
MI4301076852208000000X
NJ25MA09597700208000000X
IN01074518A208000000X
CT53473208000000X
MN64764208000000X
DEC1-0011152208000000X
MEMD20294208000000X
RIMD14794208000000X
AZ57630208000000X
WI46138208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34439500Medicaid
WI002213018Medicare ID - Type Unspecified
WI34439500Medicaid