Provider Demographics
NPI:1154343994
Name:MARKWARDT, DEBRA K (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:MARKWARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PINE RIDGE BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4123
Mailing Address - Country:US
Mailing Address - Phone:715-845-5505
Mailing Address - Fax:715-848-2884
Practice Address - Street 1:425 PINE RIDGE BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4123
Practice Address - Country:US
Practice Address - Phone:715-845-5505
Practice Address - Fax:715-848-2884
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2839820207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI25487OtherSECURITY HEALTH MEDICAID
WI31611800OtherMANAGED HEALTH CARE
WI31611800Medicaid
WI25487OtherSECURITY HEALTH PLAN
WIMARKWARDTOtherWPS
WI31611800OtherMANAGED HEALTH CARE