Provider Demographics
NPI:1821091679
Name:MARIFKE, JERALD P (MD)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:P
Last Name:MARIFKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ABBEY CT
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7471
Mailing Address - Country:US
Mailing Address - Phone:414-202-1352
Mailing Address - Fax:
Practice Address - Street 1:3551 ABBEY CT
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-7471
Practice Address - Country:US
Practice Address - Phone:414-202-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36996207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821091679Medicaid
WI73-601 0016Medicare PIN
WI1821091679Medicaid
WI1821091679Medicaid