Provider Demographics
NPI:1962476168
Name:RASTER, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RASTER
Suffix:
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:BEHAVIORAL MEDICINE CENTER
Mailing Address - Street 2:721 AMERICAN AVE SUITE 501
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188
Mailing Address - Country:US
Mailing Address - Phone:262-928-2396
Mailing Address - Fax:262-544-1213
Practice Address - Street 1:BEHAVIORAL MEDICINE CENTER
Practice Address - Street 2:721 AMERICAN AVE SUITE 501
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-928-2396
Practice Address - Fax:262-544-1213
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI399892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32464600Medicaid
WI32464600Medicaid
WI84767Medicare ID - Type Unspecified