Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2005-12-05
- Last updated
- 2026-09-21
Licenses
- License WI
- 46538
- License WI
- 46538
Location
- Practice location
- 13250 WASHINGTON AVE
- City
- MOUNT PLEASANT WI
- Postal code
- 531771516
- Phone
- 262-799-8700
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.