Provider Demographics
NPI:1821354044
Name:LABARGE, ROBYN KATHLEEN
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:KATHLEEN
Last Name:LABARGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:KATHLEEN
Other - Last Name:SAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3040 N 117TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4128
Mailing Address - Country:US
Mailing Address - Phone:414-479-9990
Mailing Address - Fax:414-479-0230
Practice Address - Street 1:3040 N 117TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-4128
Practice Address - Country:US
Practice Address - Phone:414-479-9990
Practice Address - Fax:414-479-0230
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61869-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821354044Medicaid