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Physicians Internal Medicine

Provider NPI: 1023041019

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
430 E DIVISION ST  FOND DU LAC, WI 54935-4560 US
Tel: 315-637-7800  Fax: 315-637-7808

Business Mailing Address:
420 E DIVISION ST  FOND DU LAC, WI 54935-4560 US
Tel: 920-926-8340  Fax: 920-926-8370

NPI Information:
NPI: 1023041019
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Internal Medicine
Internal Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207R00000X





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