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3130 Shore Dr Suite 111 Marinette WI 54143-4291 | |
| (715) 732-8212 | |
| (715) 732-8213 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 3130 Shore Dr, Marinette, Wisconsin |
| Authorized Official Name and Position | Dawn M Laplant (CLINIC BUSINESS SERVICES MANAGER) |
| Authorized Official Contact | 7157351722 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3100 Shore Dr Marinette WI 54143-4242 Ph: (715) 735-1721 | 3130 Shore Dr Suite 111 Marinette WI 54143-4291 Ph: (715) 732-8212 |
| NPI Number | 1073884839 |
|---|---|
| Provider Enumeration Date | 01/25/2012 |
| Last Update Date | 01/25/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073884839 | NPI | - | NPPES |
| 11001400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 155 (Wisconsin) | Primary |
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