Healthcare Provider Details

I. General information

NPI: 1508860537
Provider Name (Legal Business Name): PAUL J NEARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N HIGH ST
FORT ATKINSON WI
53538-1938
US

IV. Provider business mailing address

213 N HIGH ST
FORT ATKINSON WI
53538-1938
US

V. Phone/Fax

Practice location:
  • Phone: 920-542-5028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number26844-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number26844-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: