Provider Demographics
NPI:1861410110
Name:SENNHOLZ, TROY D (MD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:D
Last Name:SENNHOLZ
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 1:135 SOUTH GIBSON STREET
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451
Mailing Address - Country:US
Mailing Address - Phone:715-748-8100
Mailing Address - Fax:
Practice Address - Street 1:135 SOUTH GIBSON
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451
Practice Address - Country:US
Practice Address - Phone:715-748-8100
Practice Address - Fax:715-748-7590
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32589300Medicaid
WIG90072Medicare UPIN
WI002836060Medicare ID - Type Unspecified