Individual
DR. TIMOTHY S STAACKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 697-7000
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4266
(262) 787-4026
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
39495-020
WI
207LP2900X
Pain Medicine (Anesthesiology) Physician
39495
WI
208VP0014X
Interventional Pain Medicine Physician
Primary
39495
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32412100
—
WI
Enumeration date
12/02/2005
Last updated
06/29/2022
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