Healthcare Provider Details

I. General information

NPI: 1083794879
Provider Name (Legal Business Name): ASTRID G STUCKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASTRID G. STUCKE GENNANT MEINERT M.D.

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE PEDIATRIC ANESTHESIOLOGY
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE PEDIATRIC ANESTHESIOLOGY
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-3560
  • Fax: 414-266-6092
Mailing address:
  • Phone: 414-266-3560
  • Fax: 414-266-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number47693020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number47693
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: