Healthcare Provider Details

I. General information

NPI: 1952374365
Provider Name (Legal Business Name): RONALD D. FICKEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WALNUT RIDGE DRIVE PROHEALTH CARE MEDICAL ASSOCIATES, INC.
HARTLAND WI
53029-9317
US

IV. Provider business mailing address

N17 W24100 RIVERWOOD DRIVE PROHEALTH CARE MEDICAL ASSOCIATES, INC.
WAUKESHA WI
53188-1177
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-7500
  • Fax: 262-367-8744
Mailing address:
  • Phone: 262-928-4100
  • Fax: 262-928-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41572
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: