Healthcare Provider Details

I. General information

NPI: 1992762421
Provider Name (Legal Business Name): NORBERT R STRAUB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 1ST ST
PRAIRIE DU SAC WI
53578-1550
US

IV. Provider business mailing address

W10651 WILDWOOD WAY
POYNETTE WI
53955-9476
US

V. Phone/Fax

Practice location:
  • Phone: 608-643-3311
  • Fax:
Mailing address:
  • Phone: 608-516-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39210-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39210
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: