Healthcare Provider Details

I. General information

NPI: 1750564266
Provider Name (Legal Business Name): CAROLINE POIRIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 S 8TH ST
MANITOWOC WI
54220-4535
US

IV. Provider business mailing address

926 S 8TH ST
MANITOWOC WI
54220-4535
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-4230
  • Fax: 920-683-4243
Mailing address:
  • Phone: 920-683-4230
  • Fax: 920-683-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number52885
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: