| |
705 S University Ave Beaver Dam WI 53916-3053 | |
(920) 885-6090 | |
(920) 887-7973 |
Full Name | |
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Speciality | Clinic/center |
Location | 705 S University Ave, Beaver Dam, Wisconsin |
Authorized Official Name and Position | Gordon T Edwards (CFO/COO) |
Authorized Official Contact | 7153875823 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1000 N Oak Ave Attn: Provider Enrollment Services/wwp Marshfield WI 54449-5703 Ph: (715) 389-0660 | 705 S University Ave Beaver Dam WI 53916-3053 Ph: (920) 885-6090 |
NPI Number | 1851607972 |
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Provider Enumeration Date | 08/26/2010 |
Last Update Date | 03/03/2022 |
Identifier | Type | State | Issuer |
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1851607972 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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 | |
Quad/med, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Corporate Dr Ste A, Beaver Dam, WI 53916 Phone: 414-566-4000 | |
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 |