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NPI Code Detail

MEDICARE: JAD COLBY ROESKE MD

MEDICARE: JAD COLBY ROESKE MD
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
1207Q00000XFamily Medicine Physician33111WI
22083P0011XUndersea and Hyperbaric Medicine (Preventive Medicine) Physician33111WI

General Provider Information

NPI Number : 1205813011
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAD COLBY ROESKE MD
Provider Business Mailing Address
First Line : 200 1ST ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-0001
Country : US
Telephone Number : 715-838-5222
Fax Number :
Provider Business Practice Location Address
First Line : 1400 BELLINGER ST
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54703-5222
Country : US
Telephone Number : 715-838-5222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 04/19/2022

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