Individual
ALAN W ROETKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
421 CAMELOT DR, FOND DU LAC, WI 54935-8335
(920) 926-8616
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
26029
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31386600
—
WI
01
—
P00861894
RAILROAD MEDICARE
WI
Enumeration date
09/27/2006
Last updated
03/02/2016
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