Provider Demographics
NPI:1740247402
Name:VOLK, ROBERT W (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:VOLK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 26TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2204
Mailing Address - Country:US
Mailing Address - Phone:608-643-3311
Mailing Address - Fax:608-643-0048
Practice Address - Street 1:250 26TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2204
Practice Address - Country:US
Practice Address - Phone:608-643-2431
Practice Address - Fax:608-643-0048
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42999400Medicaid
P15929Medicare UPIN