Active NPI
Gretchen E Durkin, M.D.
- Otolaryngology Physician
- Milwaukee, WI
National Provider Identifier
1790900900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 24504
- Practice address
- 2350 N Lake Dr
Suite 406
Milwaukee, WI 53211-4528 - Phone
- (414) 271-4141
- Fax
- (414) 271-4343
- NPI assigned
- Apr 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 24504 | WI | Primary |
Addresses
Primary practice location
2350 N Lake Dr
Suite 406
Milwaukee, WI 53211-4528
Mailing address
4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (414) 271-4141
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30729700 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24504 | WI | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339459200000",
"number": "1790900900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4425 N PORT WASHINGTON RD",
"address_2": "ATTN: CSMCP CLINIC CREDENTIALING",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532121082",
"telephone_number": "414-271-4141",
"fax_number": "414-271-4343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2350 N LAKE DR",
"address_2": "SUITE 406",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532114528",
"telephone_number": "414-271-4141",
"fax_number": "414-271-4343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DURKIN",
"first_name": "GRETCHEN",
"middle_name": "E",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-14",
"last_updated": "2012-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "WI",
"license": "24504",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30729700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.