Provider Demographics
NPI:1154393833
Name:BOSCHEK, BRENDA L (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:BOSCHEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:N17 W24100 RIVERWOOD DR
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:1185 CORPORATE CENTER DRIVE
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4887
Practice Address - Country:US
Practice Address - Phone:262-928-8400
Practice Address - Fax:262-928-8484
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2011-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI41423207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34257100Medicaid
WI683750590Medicare PIN
WI002168765Medicare PIN
WI34257100Medicaid