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NPI Code Detail

MEDICARE: PRIMAL AIR, LLC

MEDICARE: PRIMAL AIR, LLC
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1306425251
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMAL AIR, LLC
Provider Business Mailing Address
First Line : 1266 W MAIN ST STE 2
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-1922
Country : US
Telephone Number : 608-373-4871
Fax Number :
Provider Business Practice Location Address
First Line : 1266 W MAIN ST
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-1918
Country : US
Telephone Number : 608-318-2800
Fax Number :
Authorized Official
Title or Position : BUSINESS MANAGER
Name : MR. PHILLIP AIR GUTKOWSKI
Credential :
Telephone Number : 608-373-4871
Provider Enumeration Date : 04/07/2021
Last Update Date : 04/07/2021

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Directions to “PRIMAL AIR, LLC ” Practice Location

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