Healthcare Provider Details

I. General information

NPI: 1780791285
Provider Name (Legal Business Name): DAVID A MISORSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 DOCTORS CT
JOHNSON CREEK WI
53038-9567
US

IV. Provider business mailing address

400 DOCTORS CT
JOHNSON CREEK WI
53038-9567
US

V. Phone/Fax

Practice location:
  • Phone: 920-699-4000
  • Fax: 920-699-5355
Mailing address:
  • Phone: 920-699-4000
  • Fax: 920-699-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33533
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: