Healthcare Provider Details

I. General information

NPI: 1245207604
Provider Name (Legal Business Name): JOSEPH L. ELSNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 7TH AVE W
DURAND WI
54736-1755
US

IV. Provider business mailing address

N1911 590TH ST
MENOMONIE WI
54751-5679
US

V. Phone/Fax

Practice location:
  • Phone: 715-672-5981
  • Fax:
Mailing address:
  • Phone: 715-664-8453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number47588
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47588
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: