Healthcare Provider Details

I. General information

NPI: 1417944810
Provider Name (Legal Business Name): SANDRA B MACARTHUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 ROOSEVELT RD
MARINETTE WI
54143-3834
US

IV. Provider business mailing address

PO BOX 1866
GREEN BAY WI
54305-1866
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-5225
  • Fax: 715-735-5388
Mailing address:
  • Phone: 920-445-7226
  • Fax: 920-445-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45906020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: