Healthcare Provider Details

I. General information

NPI: 1619362142
Provider Name (Legal Business Name): MICHAEL A ALBANO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 GRIFFIN ST E
AMERY WI
54001-1439
US

IV. Provider business mailing address

3221 STEIN BLVD
EAU CLAIRE WI
54701-4398
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-8000
  • Fax:
Mailing address:
  • Phone: 715-834-2788
  • Fax: 715-858-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number66183-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: