Healthcare Provider Details

I. General information

NPI: 1588742423
Provider Name (Legal Business Name): WILLIAM GREGORY PLATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 DERONDA ST
AMERY WI
54001-1412
US

IV. Provider business mailing address

230 DERONDA ST
AMERY WI
54001-1412
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-8000
  • Fax:
Mailing address:
  • Phone: 715-246-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number51022-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: