Provider Demographics
NPI:1699719476
Name:WISCONSIN MICHIGAN PHYSICIANS, SC
Entity type:Organization
Organization Name:WISCONSIN MICHIGAN PHYSICIANS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCOISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-724-6377
Mailing Address - Street 1:1601 ROOSEVELT RD
Mailing Address - Street 2:PO BOX 6
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-1043
Mailing Address - Country:US
Mailing Address - Phone:715-251-1780
Mailing Address - Fax:715-251-1787
Practice Address - Street 1:1601 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-1043
Practice Address - Country:US
Practice Address - Phone:715-225-1780
Practice Address - Fax:715-251-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34886208VP0014X
WI746200001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICD6737OtherRAILROAD MEDICARE
WICD6736OtherRAILROAD MEDICARE
MI050B210120OtherBCBS
WI21329700Medicaid
MI110B210270OtherBCBS
WI21329700Medicaid
MI0M24440Medicare PIN
WICD6736OtherRAILROAD MEDICARE
WI7464200001Medicare NSC
WI60056Medicare PIN
WI12008Medicare PIN