Provider Demographics
NPI:1881653582
Name:STUCKI, JUDITH M (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:STUCKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:405 LONDONDERRY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7921
Mailing Address - Country:US
Mailing Address - Phone:636-928-5950
Mailing Address - Fax:636-928-5952
Practice Address - Street 1:1700 W STOUT ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-5000
Practice Address - Country:US
Practice Address - Phone:715-236-8100
Practice Address - Fax:715-236-8101
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR3M52208000000X
TXQ6111208000000X, 208000000X
WI65952208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H30435Medicare UPIN