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NPI Code Detail

MEDICARE: DR. RICHARD JOSEPH DEKLOTZ M.D.

MEDICARE: DR. RICHARD JOSEPH DEKLOTZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician62714WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104169556
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD JOSEPH DEKLOTZ M.D.
Provider Business Mailing Address
First Line : 4025 N 92ND ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53222-1613
Country : US
Telephone Number : 414-358-5431
Fax Number : 414-358-5421
Provider Business Practice Location Address
First Line : 4025 N 92ND ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53222-1613
Country : US
Telephone Number : 414-358-5431
Fax Number : 414-358-5421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2013
Last Update Date : 10/10/2023

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