Healthcare Provider Details

I. General information

NPI: 1407844178
Provider Name (Legal Business Name): TIMOTHY S RAICHLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 S MADISON ST
APPLETON WI
54915-1800
US

IV. Provider business mailing address

2955 TRIVERTON PIKE DR
FITCHBURG WI
53711
US

V. Phone/Fax

Practice location:
  • Phone: 920-730-4413
  • Fax:
Mailing address:
  • Phone: 608-227-7007
  • Fax: 608-227-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number42657
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: