Individual provider Active NPI

Laura L Radke, MD

  • Infectious Disease Physician
  • Waukesha, WI
National Provider Identifier
1265516645
Registry record updated Jan 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
31373 Issued in WI
Practice address
N14W23900 Stone Ridge Dr
Prohealth Care Medical Associates
Waukesha, WI 53188-1135
Phone
(262) 574-8000
NPI assigned
Oct 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 31373 WI
Infectious Disease Physician 207RI0200X 31373 WI Primary

Addresses

Primary practice location

N14W23900 Stone Ridge Dr
Prohealth Care Medical Associates
Waukesha, WI 53188-1135

Mailing address

N14W23900 Stone Ridge Dr
Prohealth Care Medical Associates
Waukesha, WI 53188-1135
Phone (262) 574-8000

Other identifiers 1

IdentifierTypeStateIssuer
31870200MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040810001342 WI Practitioner - Infectious DiseasePractitioner - Internal Medicine 3577535509 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
31373WIMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Dec 9, 2017 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Internal Medicine CurrentSince Dec 9, 2017 Accepting new patients
The Medical College of Wisconsin, Inc. Internal Medicine Current Accepting new patients
Prohealth Medical Group Inc Internal Medicine Past Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

1701 Fond du Lac Ave
Kewaskum, WI 53040
Phone (262) 626-4616

2300 Western Ave
Manitowoc, WI 54220
Phone (920) 320-2011

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

20611 Watertown Rd
Ste J
Waukesha, WI 53186
Phone (262) 782-0000

N14W23833 Stone Ridge Dr
Ste 240
Waukesha, WI 53188
Phone (262) 232-8777

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

1700 W Paradise Dr
West Bend, WI 53095
Phone (262) 334-3451

3200 Pleasant Valley Rd
West Bend, WI 53095
Phone (262) 334-5533

Interoperability endpoints

  • Direct secure messaging: lradkemd241360@direct.froedtert.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326067200000",
    "number": "1265516645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N14W23900 STONE RIDGE DR",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881135",
            "telephone_number": "262-574-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N14W23900 STONE RIDGE DR",
            "address_2": "PROHEALTH CARE MEDICAL ASSOCIATES",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881135",
            "telephone_number": "262-574-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADKE",
        "first_name": "LAURA",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2012-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "31373",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "WI",
            "license": "31373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31870200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.