MEDICARE: LUCINDA K FENSKE M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	27618	WI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	160058538	OTHER		RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0004101092	OTHER	AETNA
2	0603214061727	OTHER	INDEPENDENT CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1811997612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCINDA K FENSKE M.D.

Provider Business Mailing Address
First Line	:	8615 N DEAN CIR
Second Line	:
City	:	RIVER HILLS
State	:	WI
Zip	:	53217-2038
Country	:	US
Telephone Number	:	414-352-8071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 N LAKE DR
Second Line	:	SUITE 502
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4507
Country	:	US
Telephone Number	:	414-271-3300
Fax Number	:	414-271-5549

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	11/17/2010

2350 N LAKE DR , RADIATION ONCOLOGY DEPT.
MILWAUKEE, WI
53211-4507

Practice Phone: 414-291-1556
Practice Fax: 414-291-1557

2320 N LAKE DR , ROOM 3603
MILWAUKEE, WI
53211-4507