Provider Demographics
NPI:1396703443
Name:SPITZER-RESNICK, SHERYL (MD)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:SPITZER-RESNICK
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 1:1001 N SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4232
Mailing Address - Country:US
Mailing Address - Phone:608-284-0202
Mailing Address - Fax:608-283-8999
Practice Address - Street 1:1001 N SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4232
Practice Address - Country:US
Practice Address - Phone:608-284-0202
Practice Address - Fax:608-283-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31442100Medicaid
WI31442100Medicaid
WI000615115Medicare ID - Type Unspecified