| Madison Medical Affiliates, Inc. | |
|
788 N Jefferson Street Suites 201,300, 401 Milwaukee WI 53202-3710 | |
| (414) 272-8950 | |
| (414) 225-2929 |
| Full Name | Madison Medical Affiliates, Inc. |
|---|---|
| Speciality | General Practice |
| Location | 788 N Jefferson Street, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Kaaren P. Butzen (CREDENTIALING) |
| Authorized Official Contact | 4142264025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Medical Affiliates, Inc. 788 N Jefferson St Suite 300/attn. Kaaren Butzen Milwaukee WI 53202-3718 Ph: (414) 272-8950 | Madison Medical Affiliates, Inc. 788 N Jefferson Street Suites 201,300, 401 Milwaukee WI 53202-3710 Ph: (414) 272-8950 |
| NPI Number | 1588695746 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 11/07/2023 |
| Medicare PECOS PAC ID | 5991606337 |
|---|---|
| Medicare Enrollment ID | O20040119000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588695746 | NPI | - | NPPES |
| 32847200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Thorsteinn Skulason |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1275506081 PECOS PAC ID: 1759370786 Enrollment ID: I20040506000969 |
| Provider Name | Deidre L Faust |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154372092 PECOS PAC ID: 2466443627 Enrollment ID: I20040518001377 |
| Provider Name | Chad J Stepke |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1093789315 PECOS PAC ID: 6204815954 Enrollment ID: I20040715001281 |
| Provider Name | Heather M Wells-holtey |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1447320403 PECOS PAC ID: 0941271647 Enrollment ID: I20040805000156 |
| Provider Name | John B Ester |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1063527547 PECOS PAC ID: 2668444613 Enrollment ID: I20040810000781 |
| Provider Name | Joseph P Regan |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1639116486 PECOS PAC ID: 0547238438 Enrollment ID: I20040921000251 |
| Provider Name | Mark L Leitschuh |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1336217066 PECOS PAC ID: 5890767537 Enrollment ID: I20040927000275 |
| Provider Name | Carmen S Balding |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1811095342 PECOS PAC ID: 0446210405 Enrollment ID: I20041013001297 |
| Provider Name | Shireen A Jayne |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1942382775 PECOS PAC ID: 8426012444 Enrollment ID: I20041118000427 |
| Provider Name | Rachel E Koebel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1104840297 PECOS PAC ID: 3173572880 Enrollment ID: I20050120000408 |
| Provider Name | Danish Siddiqui |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215987128 PECOS PAC ID: 0042262917 Enrollment ID: I20050218000539 |
| Provider Name | John R Betz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659399194 PECOS PAC ID: 3375599137 Enrollment ID: I20050324000332 |
| Provider Name | Chafik Bengana |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1881796001 PECOS PAC ID: 9436184108 Enrollment ID: I20050930000523 |
| Provider Name | John G Sanidas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356388359 PECOS PAC ID: 2769401397 Enrollment ID: I20051114000384 |
| Provider Name | James Volberding |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629007125 PECOS PAC ID: 9537060975 Enrollment ID: I20051114000458 |
| Provider Name | Kevin J Dinapoli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942254420 PECOS PAC ID: 7315966439 Enrollment ID: I20051117001005 |
| Provider Name | Abraham Varghese |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134234776 PECOS PAC ID: 0244250314 Enrollment ID: I20051205000225 |
| Provider Name | Jason G Rosenberg |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1336179340 PECOS PAC ID: 0244253540 Enrollment ID: I20060112000838 |
| Provider Name | Elaine Claire Drobny |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1265488365 PECOS PAC ID: 0345264701 Enrollment ID: I20060124000891 |
| Provider Name | Matthew F Connolly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407801996 PECOS PAC ID: 9133130487 Enrollment ID: I20060526000078 |
| Provider Name | Antoni J Gofron |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1871501593 PECOS PAC ID: 4486653052 Enrollment ID: I20061208000057 |
| Provider Name | Antonio De Villa Salud |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1093811655 PECOS PAC ID: 7113952839 Enrollment ID: I20070720000890 |
| Provider Name | Srihari R Ramanujam |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568534824 PECOS PAC ID: 4486745304 Enrollment ID: I20070807000677 |
| Provider Name | Alysandra Lal |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1538127949 PECOS PAC ID: 0143314674 Enrollment ID: I20070914000405 |
| Provider Name | Valerie B Lyon |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1215980941 PECOS PAC ID: 5294766374 Enrollment ID: I20071012000476 |
| Provider Name | Jack E Maloney |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1043272396 PECOS PAC ID: 3870680846 Enrollment ID: I20071107000720 |
| Provider Name | Dima Adl |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1851365506 PECOS PAC ID: 3173547171 Enrollment ID: I20071109000591 |
| Provider Name | Venelin J Kounev |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1902979750 PECOS PAC ID: 8921189937 Enrollment ID: I20080116000250 |
| Provider Name | Daniel T Kopesky |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1114034659 PECOS PAC ID: 9133206428 Enrollment ID: I20080410000722 |
| Provider Name | Craig A Siverhus |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1841224128 PECOS PAC ID: 7315025715 Enrollment ID: I20080425000322 |
| Provider Name | Corina J Owan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851358154 PECOS PAC ID: 4082784905 Enrollment ID: I20080604000578 |
| Provider Name | Richard P Cattey |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1548294960 PECOS PAC ID: 5496826307 Enrollment ID: I20080620000276 |
| Provider Name | Kevin R Gee |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1710975289 PECOS PAC ID: 1052483575 Enrollment ID: I20080627000493 |
| Provider Name | Christopher A Kearns |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1396732806 PECOS PAC ID: 7214009745 Enrollment ID: I20080627000513 |
| Provider Name | Debra R Scarlett |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1700802923 PECOS PAC ID: 4183797749 Enrollment ID: I20080716000175 |
| Provider Name | Anne M Lent |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1477630705 PECOS PAC ID: 7517909591 Enrollment ID: I20081027000839 |
| Provider Name | Jonathan H Berkoff |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1679623326 PECOS PAC ID: 4688738107 Enrollment ID: I20090128000553 |
| Provider Name | Kawaljeet Kaur |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1417022401 PECOS PAC ID: 7911061049 Enrollment ID: I20090204000038 |
| Provider Name | Avi N Bernstein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972643252 PECOS PAC ID: 8729138383 Enrollment ID: I20090603000141 |
| Provider Name | Scott A Jorgensen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184654725 PECOS PAC ID: 1850374810 Enrollment ID: I20100315000549 |
| Provider Name | David P Lucke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477580686 PECOS PAC ID: 2264567361 Enrollment ID: I20100315000574 |
| Provider Name | Kathleen Baugrud |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184678914 PECOS PAC ID: 4385779248 Enrollment ID: I20100317000289 |
| Provider Name | Unchu Ko |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063466886 PECOS PAC ID: 7719017490 Enrollment ID: I20100607000084 |
| Provider Name | David F Goldberg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285792127 PECOS PAC ID: 9739276353 Enrollment ID: I20101130000143 |
| Provider Name | James John Ivanoski |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1922166826 PECOS PAC ID: 9234310855 Enrollment ID: I20110301001083 |
| Provider Name | Amy M Degueme |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1548436371 PECOS PAC ID: 3274710405 Enrollment ID: I20110615000445 |
| Provider Name | Kristin M Schroederus |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1649314832 PECOS PAC ID: 3476590753 Enrollment ID: I20110922000590 |
| Provider Name | Abdullah A Fayyad |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568466019 PECOS PAC ID: 4789645821 Enrollment ID: I20121204000205 |
| Provider Name | Jennifer A Moralez |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669601241 PECOS PAC ID: 3678715562 Enrollment ID: I20130805000963 |
| Provider Name | Camile L Hexsel Folk |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1295936326 PECOS PAC ID: 6507008778 Enrollment ID: I20130819000291 |
| Provider Name | Jasna Coralic |
|---|---|
| Provider Type | Practitioner - Colorectal Surgery (proctology) |
| Provider Identifiers | NPI Number: 1528296753 PECOS PAC ID: 8325264021 Enrollment ID: I20140731002113 |
| Provider Name | Rachel M Curtin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538569488 PECOS PAC ID: 7810119583 Enrollment ID: I20141112002448 |
| Provider Name | Brent Jones |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1275777260 PECOS PAC ID: 3274788823 Enrollment ID: I20141215000402 |
| Provider Name | Amanda N Cooper |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1588808562 PECOS PAC ID: 2466689740 Enrollment ID: I20150513001091 |
| Provider Name | Nicolette E Deveneau |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1982877866 PECOS PAC ID: 4880857853 Enrollment ID: I20150727002802 |
| Provider Name | Tatyana T Radulovic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871974964 PECOS PAC ID: 9638483035 Enrollment ID: I20150729008799 |
| Provider Name | Jay S Balachandran |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1396786273 PECOS PAC ID: 8022012079 Enrollment ID: I20151229001002 |
| Provider Name | Talitha A Zinsli |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1962867879 PECOS PAC ID: 6103128061 Enrollment ID: I20160108001271 |
| Provider Name | Rachel D Oosterbaan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588690986 PECOS PAC ID: 8224161542 Enrollment ID: I20160503001452 |
| Provider Name | Tracy L Donahue |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1114230935 PECOS PAC ID: 1951520220 Enrollment ID: I20160830001547 |
| Provider Name | Alwin A Edakkunnathu |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1467899609 PECOS PAC ID: 8123250776 Enrollment ID: I20170804002374 |
| Provider Name | Usonwanne U Ibekwe |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1730509639 PECOS PAC ID: 4082989199 Enrollment ID: I20170928003388 |
| Provider Name | Heather L Bastjan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578921375 PECOS PAC ID: 9931448867 Enrollment ID: I20190311002350 |
| Provider Name | Krista T Shorey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952852477 PECOS PAC ID: 5890076384 Enrollment ID: I20190627000104 |
| Provider Name | Keely Bornor Browning |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1144676727 PECOS PAC ID: 0446542062 Enrollment ID: I20190708000441 |
| Provider Name | Katsiaryna Frantskevich |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1801280284 PECOS PAC ID: 0941513618 Enrollment ID: I20190723002565 |
| Provider Name | Lisa W Bennett |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1619354743 PECOS PAC ID: 3375846652 Enrollment ID: I20190819002200 |
| Provider Name | Christine E Pentek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821566464 PECOS PAC ID: 6103252564 Enrollment ID: I20200203000861 |
| Provider Name | Eugene Kligman |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1265872998 PECOS PAC ID: 2567602691 Enrollment ID: I20200818002607 |
| Provider Name | Sarah J Droessler |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033165444 PECOS PAC ID: 8527478957 Enrollment ID: I20201113000357 |
| Provider Name | Joseph Edward Zilisch |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1144683517 PECOS PAC ID: 5496173312 Enrollment ID: I20210622002102 |
| Provider Name | Eamen Geboy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295463743 PECOS PAC ID: 4082099445 Enrollment ID: I20220921001160 |
| Provider Name | Kathryn K Randall |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1184636672 PECOS PAC ID: 3577563725 Enrollment ID: I20230302001395 |
| Provider Name | Ann L West |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1801816277 PECOS PAC ID: 1456357144 Enrollment ID: I20230407001426 |
| Provider Name | Jacob A Thayer |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1326499930 PECOS PAC ID: 4284927955 Enrollment ID: I20230622000733 |
| Provider Name | Michael John Knabel |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1295231769 PECOS PAC ID: 2860720802 Enrollment ID: I20230814001647 |
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