Healthcare Provider Details

I. General information

NPI: 1992787535
Provider Name (Legal Business Name): MICHAEL DWAIN PLOOSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 15TH ST
BARABOO WI
53913-1502
US

IV. Provider business mailing address

635 15TH ST
BARABOO WI
53913-1502
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-3942
  • Fax: 608-356-6047
Mailing address:
  • Phone: 608-356-3942
  • Fax: 608-356-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: