Individual
NICKOLAS RUKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
N15W28300 GOLF RD, PEWAUKEE, WI 53072-4800
(262) 303-5055
(262) 303-5057
Mailing address
6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
(414) 858-4106
(414) 423-4134
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3493-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100043122
—
WI
Enumeration date
03/05/2015
Last updated
12/21/2023
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