Healthcare Provider Details

I. General information

NPI: 1447232624
Provider Name (Legal Business Name): MICHAEL D PLOOSTER MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DWAIN PLOOSTER
Title or Position: PRESIDENT /TREASURER
Credential: MD
Phone: 608-356-3942