Provider Demographics
NPI:1043237910
Name:ROOF, SANDRA K (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:ROOF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 JACKJAY DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-8302
Mailing Address - Country:US
Mailing Address - Phone:608-279-3951
Mailing Address - Fax:855-374-5850
Practice Address - Street 1:4660 S BILTMORE LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-2104
Practice Address - Country:US
Practice Address - Phone:608-284-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI733-033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043237910Medicaid
WI43868300Medicaid
WI43868300Medicaid