Provider Demographics
NPI:1366541369
Name:NETZEL, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:NETZEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-2000
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36513207K00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
520863353006OtherBC/BS
390808509OtherWPS
1002514OtherPHYSICIANS PLUS
390808509OtherCIGNA
520863353OtherTRICARE
90002361OtherWEA INS
3500226OtherMEDICARE PART B
390808509OtherCT GENERAL
11017OtherMEDICAID DEAN
32118200OtherHIRSP
WI32118200Medicaid
520863353006OtherCOMPCARE
11017OtherDEAN HEALTH PLAN
30002816OtherMEDICARE RAILROAD
520863353OtherILLINOIS PUBLIC AID
690004890OtherMEDICARE RAILROAD
39080850994OtherUNITY
520863353006OtherBC/BS MEDICARE SUPPLEMENT