Healthcare Provider Details

I. General information

NPI: 1104245018
Provider Name (Legal Business Name): KARL WILLIAM DOERFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE FL 3
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
WAUWATOSA WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5580
  • Fax: 414-476-4701
Mailing address:
  • Phone: 773-343-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number64553
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number64553-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: