Provider Demographics
NPI:1992787535
Name:PLOOSTER, MICHAEL DWAIN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DWAIN
Last Name:PLOOSTER
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 1:635 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1502
Mailing Address - Country:US
Mailing Address - Phone:608-356-3942
Mailing Address - Fax:608-356-6047
Practice Address - Street 1:635 15TH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1502
Practice Address - Country:US
Practice Address - Phone:608-356-3942
Practice Address - Fax:608-356-6047
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24021207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30407900Medicaid
W005087OtherCHAMPUS
WI57010OtherWPS
IL0300576249Medicaid
WI16007OtherDEAN HEALTH PLAN, INC
WI1992787535OtherPHYSICIANS PLLUS
WI1992787535OtherPHYSICIANS PLLUS
WI57010OtherWPS
B55768Medicare UPIN