Healthcare Provider Details

I. General information

NPI: 1902919699
Provider Name (Legal Business Name): SCOTT A ENSMINGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 1ST ST
PRAIRIE DU SAC WI
53578-1506
US

IV. Provider business mailing address

120 1ST ST
PRAIRIE DU SAC WI
53578-1506
US

V. Phone/Fax

Practice location:
  • Phone: 608-393-2855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number36639
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: