MEDICARE: CHRISTOPHER ROBERT ORGEMAN A.T.C.

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
1	2255A2300X	Athletic Trainer	803-039	WI

General Provider Information

NPI Number	:	1205965209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ROBERT ORGEMAN A.T.C.

Provider Business Mailing Address
First Line	:	102 S HUDSON ST
Second Line	:
City	:	ANTIGO
State	:	WI
Zip	:	54409-2547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W MOHAWK DR
Second Line	:	SUITE 100
City	:	TOMAHAWK
State	:	WI
Zip	:	54487-2218
Country	:	US
Telephone Number	:	715-453-7740
Fax Number	:	715-453-7717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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