Provider Demographics
NPI:1194768309
Name:SAUERHAMMER, TINA M (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:SAUERHAMMER
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 1:2200 DICKINSON RD UNIT 17B
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4070
Mailing Address - Country:US
Mailing Address - Phone:920-965-1234
Mailing Address - Fax:
Practice Address - Street 1:2700 E ENTERPRISE AVE STE A
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7656
Practice Address - Country:US
Practice Address - Phone:920-965-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48898208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery