| (inactive) Mmc - Beaver Dam - Movement & Ortho, Rehab, Pt/ot/st | |
|
705 S University Ave Ste 150 Beaver Dam WI 53916 | |
| (920) 219-4009 | |
| (920) 219-9709 |
| Full Name | (inactive) Mmc - Beaver Dam - Movement & Ortho, Rehab, Pt/ot/st |
|---|---|
| Speciality | Family Medicine - Sports Medicine |
| Location | 705 S University Ave Ste 150, Beaver Dam, Wisconsin |
| Authorized Official Name and Position | Gordon T Edwards (CFO/COO/AO) |
| Authorized Official Contact | 7153875823 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| (inactive) Mmc - Beaver Dam - Movement & Ortho, Rehab, Pt/ot/st 1000 N Oak Ave Attn: Provider Enrollment Services/wwp Marshfield WI 54449-5703 Ph: (715) 389-0660 | (inactive) Mmc - Beaver Dam - Movement & Ortho, Rehab, Pt/ot/st 705 S University Ave Ste 150 Beaver Dam WI 53916 Ph: (920) 219-4009 |
| NPI Number | 1023310034 |
|---|---|
| Provider Enumeration Date | 11/23/2010 |
| Last Update Date | 03/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023310034 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
Paladina Health Beaver Dam Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Corporate Dr, Suite A, Beaver Dam, WI 53916 Phone: 920-351-4530 | |
Ayaz Samandani Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Corporate Dr, Suite H, Beaver Dam, WI 53916 Phone: 920-887-7731 Fax: 920-887-3201 | |
Ayaz M. Samadani, Md, Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Corporate Dr, Suite H, Beaver Dam, WI 53916 Phone: 920-887-7731 | |
(inactive) Marshfield Medical Center - Beaver Dam Specialty Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 705 S University Ave Ste 360, Beaver Dam, WI 53916 Phone: 920-356-6588 Fax: 920-356-6567 | |
(inactive) Marshfield Medical Center - Beaver Dam Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 130 Warren St Ste 132, Beaver Dam, WI 53916 Phone: 920-887-7181 Fax: 920-887-6833 | |
Victor W. Caceres, M.d.,s.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 919 S. University Avenue, Beaver Dam, WI 53916 Phone: 920-885-9238 Fax: 920-885-4405 |