Healthcare Provider Details

I. General information

NPI: 1770386633
Provider Name (Legal Business Name): JUSTIN ADAM FERKIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 NW BARSTOW ST
WAUKESHA WI
53188-3771
US

IV. Provider business mailing address

1409 CHAPMAN DR
WAUKESHA WI
53189-7258
US

V. Phone/Fax

Practice location:
  • Phone: 262-548-6903
  • Fax:
Mailing address:
  • Phone: 262-496-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPAR-0000650229
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: