Individual
MR. TERRANCE E. DERKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-3518
(414) 805-3666
Mailing address
10000 W INNOVATION DR, MILWAUKEE, WI 53226-4837
(414) 456-5006
(414) 456-6259
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
401
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42953300
—
WI
Enumeration date
07/26/2006
Last updated
07/09/2007
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