Individual
BRADLEY THEODORE JOHN STRAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2607 N GRANDVIEW BLVD, STE 125, WAUKESHA, WI 53188-1686
(414) 455-0919
(414) 455-0905
Mailing address
2607 N GRANDVIEW BLVD, STE 125, WAUKESHA, WI 53188-1686
(262) 290-4540
(262) 229-2220
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
44600020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070017187
RAILROAD MEDICARE
WI
01
—
070017188
RAILROAD MEDICARE
WI
05
—
34279600
—
WI
Enumeration date
08/30/2005
Last updated
06/03/2017
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