Healthcare Provider Details

I. General information

NPI: 1063780658
Provider Name (Legal Business Name): LIFEVIEW CARE WISCONSIN S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 AMERICAN BLVD W STE 225
BLOOMINGTON MN
55431-4527
US

IV. Provider business mailing address

901 S WHITNEY WAY
MADISON WI
53711-2553
US

V. Phone/Fax

Practice location:
  • Phone: 952-500-3337
  • Fax: 855-715-1907
Mailing address:
  • Phone: 952-500-3337
  • Fax: 855-715-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS RAY HARMAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 952-500-3337