Provider Demographics
NPI:1831131390
Name:MARKEY, EDMUND LAWRENCE JR (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:LAWRENCE
Last Name:MARKEY
Suffix:JR
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 1:425 PINE RIDGE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4123
Mailing Address - Country:US
Mailing Address - Phone:715-847-0402
Mailing Address - Fax:715-847-0429
Practice Address - Street 1:425 PINE RIDGE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4123
Practice Address - Country:US
Practice Address - Phone:715-847-0402
Practice Address - Fax:715-847-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17315207X00000X, 207XS0114X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30201000Medicaid
WI30201000Medicaid
AM9039264OtherDRUG ENFORCEMENT ADMIN
WID80080Medicare UPIN