Healthcare Provider Details

I. General information

NPI: 1699719476
Provider Name (Legal Business Name): WISCONSIN MICHIGAN PHYSICIANS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 ROOSEVELT RD
NIAGARA WI
54151-1043
US

IV. Provider business mailing address

1601 ROOSEVELT RD PO BOX 6
NIAGARA WI
54151-1043
US

V. Phone/Fax

Practice location:
  • Phone: 715-225-1780
  • Fax: 715-251-1787
Mailing address:
  • Phone: 715-251-1780
  • Fax: 715-251-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number746200001
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number34886
License Number StateWI

VIII. Authorized Official

Name: DR. FRANCOISE SINGH
Title or Position: CHIEF OPERATING OFFICER
Credential: MD
Phone: 888-724-6377