Provider Demographics
NPI:1952378630
Name:BAHRKE, BARBARA A (PA-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BAHRKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11516 N PORT WASHINGTON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3478
Mailing Address - Country:US
Mailing Address - Phone:262-241-5040
Mailing Address - Fax:
Practice Address - Street 1:1033 N MAYFAIR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3442
Practice Address - Country:US
Practice Address - Phone:414-454-0600
Practice Address - Fax:414-454-0971
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1291363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP28506Medicare UPIN
WI650030037Medicare PIN
WI738440085Medicare PIN
WI525400081Medicare PIN