Healthcare Provider Details

I. General information

NPI: 1073001996
Provider Name (Legal Business Name): ALLEGRA PONSHOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLEGRA PARRILLO MD

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 DIVISION ST
MAUSTON WI
53948-1998
US

IV. Provider business mailing address

1040 DIVISION ST
MAUSTON WI
53948-1998
US

V. Phone/Fax

Practice location:
  • Phone: 608-847-5000
  • Fax:
Mailing address:
  • Phone: 608-847-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number68011
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77998-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: