Healthcare Provider Details

I. General information

NPI: 1871949834
Provider Name (Legal Business Name): ELIZABETH SPRAGUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY STE 1080
MILWAUKEE WI
53215-3689
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY STE 1080
MILWAUKEE WI
53215-3689
US

V. Phone/Fax

Practice location:
  • Phone: 414-454-0600
  • Fax: 262-767-6023
Mailing address:
  • Phone: 414-908-6500
  • Fax: 414-908-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68328
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.135865
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.135865
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number68328-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: