Healthcare Provider Details

I. General information

NPI: 1558294124
Provider Name (Legal Business Name): JAMES MICHAEL SUCHANEK EMT,PERSONALTRAINER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W JEFFERSON ST
BLACK RIVER FALLS WI
54615-1063
US

IV. Provider business mailing address

216 N 10TH ST
BLACK RIVER FALLS WI
54615-1148
US

V. Phone/Fax

Practice location:
  • Phone: 715-670-0080
  • Fax:
Mailing address:
  • Phone: 715-896-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0019840
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: