Provider Demographics
NPI:1588771034
Name:LAUS, COLLEEN M (MD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:M
Last Name:LAUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARGARET
Other - Last Name:LAUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:W165 N5595 CREEKWOOD CROSSING
Mailing Address - Street 2:KOHL'S WELLNESS CENTER
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051
Mailing Address - Country:US
Mailing Address - Phone:262-252-1060
Mailing Address - Fax:262-252-4781
Practice Address - Street 1:W165 N5595 CREEKWOOD CROSSING
Practice Address - Street 2:KOHL'S WELLNESS CENTER
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051
Practice Address - Country:US
Practice Address - Phone:262-252-1060
Practice Address - Fax:262-252-4781
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46455208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34510800Medicaid
WI34510800Medicaid
108798Medicare UPIN