Provider Demographics
NPI:1902879737
Name:SIERASKI, MADELYN C (MD)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:C
Last Name:SIERASKI
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:WAUKESHA HEALTH CARE INC.
Mailing Address - Street 2:N17 W24100 RIVERWOOD DRIVE SUITE 250
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:PROHEALTH CARE MEDICAL CENTERS-SOUTH
Practice Address - Street 2:2130 BIG BEND ROAD
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189
Practice Address - Country:US
Practice Address - Phone:262-928-7555
Practice Address - Fax:262-513-7575
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2009-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI32517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31755700Medicaid
WI31755700Medicaid
WI000168580Medicare PIN