MEDICARE: MRS. CASIE A FRIEDRICH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	4547-23	WI

General Provider Information

NPI Number	:	1699242032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASIE A FRIEDRICH PA-C

Provider Business Mailing Address
First Line	:	10001 W INNOVATION DR STE 200
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-4851
Country	:	US
Telephone Number	:	414-771-6780
Fax Number	:	414-238-2424

Provider Business Practice Location Address
First Line	:	8500 75TH ST
Second Line	:	STE 101
City	:	PLEASANT PRAIRIE
State	:	WI
Zip	:	53158-2049
Country	:	US
Telephone Number	:	888-938-3838
Fax Number	:	888-919-1083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	04/23/2025

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