Facts
- Status
- A
- Credential
- RHD
- Type
- Individual
- Enumeration date
- 2013-06-24
- Last updated
- 2013-06-24
Specialties
Licenses
- License WI
- 11007-16
Location
- Practice location
- 53585 NOKOMIS RD
- City
- ASHLAND WI
- Postal code
- 548064272
- Phone
- 715-685-7887
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.