Provider Demographics
NPI:1992881361
Name:MOTARJEME, MARESHIA G
Entity type:Individual
Prefix:MS
First Name:MARESHIA
Middle Name:G
Last Name:MOTARJEME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARESHIA
Other - Middle Name:G
Other - Last Name:LINENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:17100 W NORTH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-784-3800
Mailing Address - Fax:262-784-7936
Practice Address - Street 1:17100 W NORTH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-784-3800
Practice Address - Fax:262-784-7936
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI858023207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S39644Medicare UPIN