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NPI Code Detail

MEDICARE: DR. MICHAELA HYUNJOO TONG M.D.

MEDICARE: DR. MICHAELA HYUNJOO TONG M.D.
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
1207Q00000XFamily Medicine Physician64505-20WI

General Provider Information

NPI Number : 1528044401
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAELA HYUNJOO TONG M.D.
Provider Business Mailing Address
First Line : 15954 RIVERS EDGE DR STE 101
Second Line :
City : HAYWARD
State : WI
Zip : 54843-7887
Country : US
Telephone Number : 715-634-2541
Fax Number : 715-634-5740
Provider Business Practice Location Address
First Line : 15954 RIVERS EDGE DR
Second Line :
City : HAYWARD
State : WI
Zip : 54843-7800
Country : US
Telephone Number : 715-634-2541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 10/02/2024

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Directions to “ DR. MICHAELA HYUNJOO TONG M.D.” Practice Location

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