Provider Demographics
NPI:1932129921
Name:HARTKE, KATHY D (MD SC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:D
Last Name:HARTKE
Suffix:
Gender:F
Credentials:MD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1348
Practice Address - Country:US
Practice Address - Phone:608-287-2830
Practice Address - Fax:608-287-2845
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26058207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31374100Medicaid
WI1932129921Medicaid
B56962Medicare UPIN
WI31374100Medicaid
WI000068304Medicare PIN