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NPI Code Detail

MEDICARE: MICHAEL D VAD CRNA

MEDICARE: MICHAEL D VAD CRNA
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
1367500000XCertified Registered Nurse AnesthetistR-158100-7MN
2367500000XCertified Registered Nurse Anesthetist76740MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1097N8VAOTHERMNBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215028170
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL D VAD CRNA
Provider Business Mailing Address
First Line : 130 S KNOWLES AVE
Second Line : PO BOX 118
City : NEW RICHMOND
State : WI
Zip : 54017-0118
Country : US
Telephone Number : 715-246-3018
Fax Number : 715-246-3019
Provider Business Practice Location Address
First Line : 130 S KNOWLES AVE
Second Line :
City : NEW RICHMOND
State : WI
Zip : 54017-1727
Country : US
Telephone Number : 715-246-3018
Fax Number : 715-246-3019
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 04/18/2019

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