Full Name | |
---|---|
Speciality | Family Medicine |
Location | 307 Manor Dr, Suring, Wisconsin |
Authorized Official Name and Position | Denise K Stroobants (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 9204457222 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
307 Manor Dr Suring WI 54174-9182 Ph: (920) 842-2144 | 307 Manor Dr Suring WI 54174-9182 Ph: (920) 842-2144 |
NPI Number | 1164484861 |
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Provider Enumeration Date | 04/06/2006 |
Last Update Date | 02/26/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164484861 | NPI | - | NPPES |
32855800 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |