Provider Demographics
NPI:1013982834
Name:MCCALL, TRACY E (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:E
Last Name:MCCALL
Suffix:
Gender:F
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:N19W24075 RIVERWOOD DR STE 228
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1170
Mailing Address - Country:US
Mailing Address - Phone:262-523-1200
Mailing Address - Fax:262-523-1230
Practice Address - Street 1:N19W24075 RIVERWOOD DR STE 228
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1170
Practice Address - Country:US
Practice Address - Phone:262-523-1200
Practice Address - Fax:262-523-1230
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43479-020208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI201461107018OtherBLUE CROSS AND BLUE SHIEL
WI34144000Medicaid
WIH39851Medicare UPIN
WI000068164Medicare ID - Type Unspecified