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NPI Code Detail

MEDICARE: DR. ETHAN JAMES YOUNG D.O.

MEDICARE: DR. ETHAN JAMES YOUNG D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician5101021818MI
2207PE0004XEmergency Medical Services (Emergency Medicine) PhysicianS0411TX
3207P00000XEmergency Medicine PhysicianS0411TX
4207P00000XEmergency Medicine Physician73154-21WI
5207PE0004XEmergency Medical Services (Emergency Medicine) Physician73154-21WI

General Provider Information

NPI Number : 1053792895
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ETHAN JAMES YOUNG D.O.
Provider Business Mailing Address
First Line : 900 W CLAIREMONT AVE
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54701-6122
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2661 COUNTY HIGHWAY I
Second Line :
City : CHIPPEWA FALLS
State : WI
Zip : 54729-5407
Country : US
Telephone Number : 715-723-1811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2015
Last Update Date : 03/25/2026

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