Straka, Bradley Theodore John

Straka, Bradley Theodore John is an individual health care provider with primary practice located at 2607 N Grandview Blvd Ste 125, Waukesha WI 53188-1686. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Straka, Bradley Theodore John can be contacted via phone (414) 455-0919.

Contact Information

Primary practice address
2607 N Grandview Blvd Ste 125 Waukesha WI 53188-1686
Phone: (414) 455-0919
Fax: (414) 455-0905
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 44600020 Wisconsin

Profile Details

NPI number 1326031964
LBN Legal business name Straka, Bradley Theodore John
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 2005
Last updated Jun 3rd, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326031964 NPPES
Wisconsin MEDICAID 34279600
Wisconsin Other 070017188
Wisconsin Other 070017187

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