Provider Demographics
NPI:1811997612
Name:FENSKE, LUCINDA K (MD)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:K
Last Name:FENSKE
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 1:8615 N DEAN CIR
Mailing Address - Street 2:
Mailing Address - City:RIVER HILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2038
Mailing Address - Country:US
Mailing Address - Phone:414-352-8071
Mailing Address - Fax:
Practice Address - Street 1:2350 N LAKE DR
Practice Address - Street 2:SUITE 502
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4507
Practice Address - Country:US
Practice Address - Phone:414-271-3300
Practice Address - Fax:414-271-5549
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27618207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004101092OtherAETNA
0603214061727OtherINDEPENDENT CARE
WI31504100Medicaid
160058538OtherRAILROAD MEDICARE
160058538OtherRAILROAD MEDICARE
0004101092OtherAETNA