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2925 Columbia Dr Portage WI 53901-9485 | |
(608) 742-9100 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 2925 Columbia Dr, Portage, Wisconsin |
Authorized Official Name and Position | Dalia Suliene (PHYSICIAN) |
Authorized Official Contact | 6087429100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2925 Columbia Dr Portage WI 53901-9485 Ph: () - | 2925 Columbia Dr Portage WI 53901-9485 Ph: (608) 742-9100 |
NPI Number | 1760522452 |
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Provider Enumeration Date | 02/08/2007 |
Last Update Date | 05/23/2008 |
Identifier | Type | State | Issuer |
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1760522452 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 28096 (Wisconsin) | Primary |