Individual
TOM R PANKRATZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
707 14TH ST, BARABOO, WI 53913-1539
(608) 356-1400
Mailing address
707 14TH ST, BARABOO, WI 53913-1539
(608) 356-1400
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
042315
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1009390
PHYS PLUS PROV #
WI
01
—
388407992
TRICARE PROV #
WI
01
—
391023846
COMMERCIAL INS PROV #
WI
01
—
430054481
RR MEDICARE PROV #
WI
05
—
43322800
—
WI
01
—
551896
DEANCARE PROV #
WI
Enumeration date
11/17/2005
Last updated
03/09/2010
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