Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2006-06-19
- Last updated
- 2016-05-23
Specialties
Licenses
- License MN
- 28487
- License WI
- 52179
Location
- Practice location
- 1615 MAPLE LN STE 1
- City
- ASHLAND WI
- Postal code
- 548063610
- Phone
- 715-685-7500
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.