Healthcare Provider Details

I. General information

NPI: 1922920842
Provider Name (Legal Business Name): MD GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S MAIN ST
DEFOREST WI
53532-1421
US

IV. Provider business mailing address

333 LOWVILLE RD
RIO WI
53960-9437
US

V. Phone/Fax

Practice location:
  • Phone: 608-846-4736
  • Fax: 608-846-6892
Mailing address:
  • Phone: 920-992-6800
  • Fax: 920-614-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DIANE DEANS
Title or Position: CONTRACTING MANAGER
Credential:
Phone: 920-992-6800