Provider Demographics
NPI:1336125939
Name:MOLASKA, WENDY L (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:MOLASKA
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 1:3034 BOSSHARD DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5858
Mailing Address - Country:US
Mailing Address - Phone:612-770-8695
Mailing Address - Fax:
Practice Address - Street 1:2990 TRIVERTON PIKE DR # 101
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5904
Practice Address - Country:US
Practice Address - Phone:608-305-4515
Practice Address - Fax:608-721-6006
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42881207Q00000X
WI51915-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34288500Medicaid
WI60752OtherDEAN HEALTH INSURANCE
CO52103234Medicaid
H69213Medicare UPIN
CO548098Medicare PIN
WI60752OtherDEAN HEALTH INSURANCE