Healthcare Provider Details

I. General information

NPI: 1164415519
Provider Name (Legal Business Name): GERHARD KARL KRASKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 ELMWOOD AVE. SUITE 201
MIDDLETON WI
53562-5407
US

IV. Provider business mailing address

202 S PARK ST
MADISON WI
53715-1507
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-3434
  • Fax: 608-828-3444
Mailing address:
  • Phone: 608-417-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101240703
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: