MEDICARE: MILE BLUFF MEDICAL CENTER

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	261QP2300X	Primary Care Clinic/Center	6726-33	WI

General Provider Information

NPI Number	:	1427413483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE BLUFF MEDICAL CENTER

Provider Business Mailing Address
First Line	:	901 W BRIDGE ST
Second Line	:
City	:	NEW LISBON
State	:	WI
Zip	:	53950-1083
Country	:	US
Telephone Number	:	608-562-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 W BRIDGE ST
Second Line	:
City	:	NEW LISBON
State	:	WI
Zip	:	53950-1083
Country	:	US
Telephone Number	:	608-562-3111
Fax Number	:

Authorized Official
Title or Position	:	VP, CMO
Name	:	DR. TIMOTHY BJELLAND
Credential	:	D.O.
Telephone Number	:	608-847-9826

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	12/17/2015

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Directions to “MILE BLUFF MEDICAL CENTER ” Practice Location

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