Organization
CENTRAL WISCONSIN ANESTHESI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN J DOMKE (OFFICE MANAGER)
(920) 361-5538
Entity
Organization
Contact information
Practice address
225 MEMORIAL DR, BERLIN, WI 54923-1243
(920) 361-5538
(920) 361-5499
Mailing address
225 MEMORIAL DR, BERLIN, WI 54923-1243
(920) 361-5538
(920) 361-5499
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000021415
MEDICARE
WI
01
—
000026095
MEDICARE
WI
05
—
43419700
—
WI
Enumeration date
10/12/2006
Last updated
11/05/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up