Healthcare Provider Details

I. General information

NPI: 1639254022
Provider Name (Legal Business Name): ALLAN W. TORKELSON, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

IV. Provider business mailing address

13111 N PORT WASHINGTON RD
MEQUON WI
53097-2416
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-7410
  • Fax: 262-243-7482
Mailing address:
  • Phone: 262-968-9190
  • Fax: 262-968-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20837
License Number StateWI

VIII. Authorized Official

Name: ALLAN W. TORKELSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 262-243-7410