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NPI Code Detail

MEDICARE: URO GYN CONSULTATIONS LLC

MEDICARE: URO GYN CONSULTATIONS LLC
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
1363L00000XNurse Practitioner84725-30WI

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 : 1245677392
Entity Type Code : Organization
Provider Name (Legal Business Name) : URO GYN CONSULTATIONS LLC
Provider Business Mailing Address
First Line : 2020 COUNTY ROAD Z
Second Line :
City : BLUE MOUNDS
State : WI
Zip : 53517-9629
Country : US
Telephone Number : 608-437-6035
Fax Number : 608-437-6035
Provider Business Practice Location Address
First Line : 8301 OLD SAUK RD
Second Line :
City : MIDDLETON
State : WI
Zip : 53562-4389
Country : US
Telephone Number : 608-662-8842
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KELLY KRUSE
Credential : MS, APNP
Telephone Number : 608-437-6035
Provider Enumeration Date : 05/30/2013
Last Update Date : 05/30/2013

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