MEDICARE: TARA STREIT PA-C

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
1	363AM0700X	Medical Physician Assistant	3757	WI

General Provider Information

NPI Number	:	1811348006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA STREIT PA-C

Provider Business Mailing Address
First Line	:	1025 PASADENA PKWY
Second Line	:
City	:	WAUNAKEE
State	:	WI
Zip	:	53597-1921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 PASADENA PKWY
Second Line	:
City	:	WAUNAKEE
State	:	WI
Zip	:	53597-1921
Country	:	US
Telephone Number	:	608-235-7745
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2016
Last Update Date	:	07/05/2021

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Directions to “ TARA STREIT PA-C” Practice Location

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