Healthcare Provider Details

I. General information

NPI: 1154372829
Provider Name (Legal Business Name): RICHARD A ROLAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S ONEIDA ST
APPLETON WI
54915-1305
US

IV. Provider business mailing address

3420 JACKSON ST SUITE E
OSHKOSH WI
54901-8144
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-2000
  • Fax:
Mailing address:
  • Phone: 920-426-2211
  • Fax: 920-426-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number43079020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: