Healthcare Provider Details

I. General information

NPI: 1053792895
Provider Name (Legal Business Name): ETHAN JAMES YOUNG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2661 COUNTY HIGHWAY I
CHIPPEWA FALLS WI
54729-5407
US

IV. Provider business mailing address

900 W CLAIREMONT AVE
EAU CLAIRE WI
54701-6122
US

V. Phone/Fax

Practice location:
  • Phone: 715-723-1811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101021818
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberS0411
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberS0411
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number73154-21
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number73154-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: