Healthcare Provider Details

I. General information

NPI: 1972780237
Provider Name (Legal Business Name): NANCY M ROFALIKOS-WELKA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 FORREST DR
WATERFORD WI
53185-4577
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-514-3700
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49917
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: