Healthcare Provider Details

I. General information

NPI: 1578940375
Provider Name (Legal Business Name): KATIE SATULA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 W JANESVILLE RD STE 6
HALES CORNERS WI
53130-2327
US

IV. Provider business mailing address

W198S10846 RACINE AVE
MUSKEGO WI
53150-8457
US

V. Phone/Fax

Practice location:
  • Phone: 414-425-1510
  • Fax: 414-425-1861
Mailing address:
  • Phone: 414-550-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1001086 - 15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: