Provider Demographics
NPI:1457614463
Name:SPOLTMAN, KATE ELIZABETH (AA)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:ELIZABETH
Last Name:SPOLTMAN
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:SPOLTMAN
Other - Last Name:MAKOCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:840 N 87TH ST
Mailing Address - Street 2:FROEDTERT SURGERY CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3586
Mailing Address - Country:US
Mailing Address - Phone:414-805-9500
Mailing Address - Fax:414-805-9501
Practice Address - Street 1:840 N 87TH ST
Practice Address - Street 2:FROEDTERT SURGERY CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-805-9500
Practice Address - Fax:414-805-9501
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1469367H00000X
WI52367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457614463Medicaid