Search › Wisconsin › 164W00000X
Derek Raese
NPI 1205309226 · on the registry since 2019 · sole proprietor
Practice
- Address
- 16320 W Marietta Dr
New Berlin, WI 53151 - Phone
- (414) 640-1112
- Clinicians at this address
- 2
Registry record
- Primary taxonomy
- 164W00000X
164W00000X
- Licence states on file
- WI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-01-03
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Wisconsin