Provider Demographics
NPI:1043261886
Name:KRASOVICH, SUSANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:M
Last Name:KRASOVICH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:210 NW BARSTOW ST
Mailing Address - Street 2:WAUKESHA FAMILY PRACTICE CENTER
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3771
Mailing Address - Country:US
Mailing Address - Phone:262-548-6903
Mailing Address - Fax:262-548-3820
Practice Address - Street 1:210 NW BARSTOW ST
Practice Address - Street 2:WAUKESHA FAMILY PRACTICE CENTER
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3771
Practice Address - Country:US
Practice Address - Phone:262-548-6903
Practice Address - Fax:262-548-3820
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-10-08
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Provider Licenses
StateLicense IDTaxonomies
WI47105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
029906261QOtherHUMANA
WI1043261886Medicaid
WI1043261886Medicaid
WI0238 68-086Medicare PIN