Provider Demographics
NPI:1992457261
Name:BISHOP, MICHAEL CORNELIUS
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CORNELIUS
Last Name:BISHOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:KOHLER
Mailing Address - State:WI
Mailing Address - Zip Code:53044-1429
Mailing Address - Country:US
Mailing Address - Phone:920-207-6294
Mailing Address - Fax:
Practice Address - Street 1:3711 S TAYLOR DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-8495
Practice Address - Country:US
Practice Address - Phone:920-459-8601
Practice Address - Fax:920-459-8662
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40-9370183500000X
WI9370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist