Provider Demographics
NPI:1154388213
Name:CROFT, HOWARD J (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:CROFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2900
Mailing Address - Country:US
Mailing Address - Phone:608-669-5422
Mailing Address - Fax:888-384-2618
Practice Address - Street 1:10556 N PORT WASHINGTON RD # 204
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5586
Practice Address - Country:US
Practice Address - Phone:262-292-1892
Practice Address - Fax:262-292-1255
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27912-020207P00000X
WI27912207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1154388213Medicaid
WI930068399OtherMEDICARE RAILROAD
WIP00233038OtherMEDICARE RAILROAD
WI080097548OtherMEDICARE RAILROAD
WI31438700Medicaid
WI080097548OtherMEDICARE RAILROAD
WI0014-60045Medicare ID - Type Unspecified
WI0009-32350Medicare ID - Type Unspecified
WI0001-68655Medicare ID - Type Unspecified
WI31438700Medicaid
WI0004-07660Medicare ID - Type Unspecified