1467406124 NPI number — JAMES M NOSAL MD

Table of content: JAMES M NOSAL MD (NPI 1467406124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467406124 NPI number — JAMES M NOSAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOSAL
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467406124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8201 MISH KO SWEN DRIVE
Provider Second Line Business Mailing Address:
PO BOX 396
Provider Business Mailing Address City Name:
CRANDON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54520-0396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-478-4300
Provider Business Mailing Address Fax Number:
715-478-4499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 TOWER DR
Provider Second Line Business Practice Location Address:
DEAN MEDICAL CENTER
Provider Business Practice Location Address City Name:
SUN PRAIRIE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53590-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-825-3008
Provider Business Practice Location Address Fax Number:
608-825-3794
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  28410-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30816900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3892 . This is a "DEAN HEALTH INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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