Healthcare Provider Details

I. General information

NPI: 1831114792
Provider Name (Legal Business Name): ROSS ANTHONY FICARRI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 DOUSMAN ST
GREEN BAY WI
54303-3211
US

IV. Provider business mailing address

PO BOX 19070 PREVEA HEALTH
GREEN BAY WI
54307-9070
US

V. Phone/Fax

Practice location:
  • Phone: 920-496-4700
  • Fax: 920-496-4705
Mailing address:
  • Phone: 920-496-4700
  • Fax: 920-496-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1068
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: