Provider Demographics
NPI:1003915570
Name:GNADT, JOAN T (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:T
Last Name:GNADT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2617 N WAHL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3826
Mailing Address - Country:US
Mailing Address - Phone:143-321-5714
Mailing Address - Fax:414-332-1579
Practice Address - Street 1:5000 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:414-382-5150
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI28835207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31543000Medicaid
WI000146425Medicare ID - Type UnspecifiedMEDICARE-OZAUKEE
WI31543000Medicaid
WI000101344Medicare ID - Type UnspecifiedMEDICARE-MILWAUKEE