Provider Demographics
NPI:1174602619
Name:TROTMAN, ENID A (MD)
Entity type:Individual
Prefix:
First Name:ENID
Middle Name:A
Last Name:TROTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14195 N TWIN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-1309
Mailing Address - Country:US
Mailing Address - Phone:414-305-4954
Mailing Address - Fax:
Practice Address - Street 1:14195 N TWIN OAKS LN
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-1309
Practice Address - Country:US
Practice Address - Phone:414-305-4954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31452400Medicaid
WIB57207Medicare UPIN