Healthcare Provider Details

I. General information

NPI: 1811925282
Provider Name (Legal Business Name): JAMES F SPLIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S MAIN ST
OCONTO FALLS WI
54154-1241
US

IV. Provider business mailing address

855 S MAIN ST
OCONTO FALLS WI
54154-1241
US

V. Phone/Fax

Practice location:
  • Phone: 920-846-3444
  • Fax: 920-846-0250
Mailing address:
  • Phone: 920-846-3444
  • Fax: 920-846-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01066745A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number10904
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number58255-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: