Healthcare Provider Details

I. General information

NPI: 1417043449
Provider Name (Legal Business Name): NATHANIEL S JALIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 CRAIG ROAD
EAU CLAIRE WI
54701
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5777
US

V. Phone/Fax

Practice location:
  • Phone: 715-858-4718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34338
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number34338
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: