Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2026-05-11
- Last updated
- 2026-05-11
Specialties
Licenses
- License WI
- 201554
Location
- Practice location
- W23597 US HIGHWAY 10
- City
- STRUM WI
- Postal code
- 547708609
- Phone
- 715-695-2696
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.