Provider Demographics
NPI:1902863442
Name:DEMERY, PATRICIA M (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:DEMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:O'LEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N9554 HIGHLINE RD
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-8502
Mailing Address - Country:US
Mailing Address - Phone:920-277-9716
Mailing Address - Fax:
Practice Address - Street 1:N9554 HIGHLINE RD
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-8502
Practice Address - Country:US
Practice Address - Phone:920-277-9716
Practice Address - Fax:920-766-1415
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32560-020207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31750000Medicaid
WIF00913Medicare UPIN
WI024407650Medicare ID - Type Unspecified