Healthcare Provider Details

I. General information

NPI: 1316465073
Provider Name (Legal Business Name): AUSTIN PAUL DAMASCHKE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W CHAMBERS ST
MILWAUKEE WI
53210-1650
US

IV. Provider business mailing address

20529 84TH PL
BRISTOL WI
53104-9150
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-2171
  • Fax:
Mailing address:
  • Phone: 262-945-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4189-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4189-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: