MEDICARE: JANE E MAHONEY MD

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	208D00000X	General Practice Physician	28677	WI

General Provider Information

NPI Number	:	1538136023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE E MAHONEY MD

Provider Business Mailing Address
First Line	:	655 SUMAC ST
Second Line	:
City	:	OREGON
State	:	WI
Zip	:	53575-3439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 SUMAC ST
Second Line	:
City	:	OREGON
State	:	WI
Zip	:	53575-3439
Country	:	US
Telephone Number	:	608-576-7208
Fax Number	:

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	11/19/2024

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