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General NPI Number Information
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NPI Number | 1891716700
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Entity Type | Individual
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Provider Name | TRACI A. PURATH M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 565 MILWAUKEE AVE SUITE 2-C
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City | BURLINGTON
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State | WI
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Zip | 53105-1254
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Country | US
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Telephone | 262-694-5000
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Fax | 262-661-4606
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Provider Business Mailing Address
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Address Line | 5244 ZACHARY DR
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City | MOUNT PLEASANT
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State | WI
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Zip | 53403-9795
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Country | US
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Telephone | 262-694-5000
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Fax | 262-661-4606
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 40525-020
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License Number State | WI
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