Healthcare Provider Details

I. General information

NPI: 1093238347
Provider Name (Legal Business Name): HUDSON PHYSICIANS, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 SPRUCE ST
BALDWIN WI
54002-3264
US

IV. Provider business mailing address

2651 HILLCREST DR STE 303
HUDSON WI
54016-9919
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6800
  • Fax: 715-531-6801
Mailing address:
  • Phone: 715-531-6800
  • Fax: 715-531-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERNIE WALLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-531-6862