| Mark A Midthun Md Llc | |
|
3626 East Ave S Ste 2a La Crosse WI 54601-7221 | |
| (608) 778-1114 | |
| (608) 778-1147 |
| Full Name | Mark A Midthun Md Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3626 East Ave S Ste 2a, La Crosse, Wisconsin |
| Authorized Official Name and Position | Mark A. Midthun (PSYCHIATRIST) |
| Authorized Official Contact | 6083975904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark A Midthun Md Llc W6602 Schilling Rd Unit C Onalaska WI 54650-9343 Ph: (608) 397-5904 | Mark A Midthun Md Llc 3626 East Ave S Ste 2a La Crosse WI 54601-7221 Ph: (608) 778-1114 |
| NPI Number | 1740830512 |
|---|---|
| Provider Enumeration Date | 09/13/2019 |
| Last Update Date | 03/30/2020 |
| Certification Date | 03/30/2020 |
| Medicare PECOS PAC ID | 9931431202 |
|---|---|
| Medicare Enrollment ID | O20191106001304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740830512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Mark A Midthun |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487721791 PECOS PAC ID: 8527053966 Enrollment ID: I20070822001069 |
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