Healthcare Provider Details

I. General information

NPI: 1114053048
Provider Name (Legal Business Name): COMMUNITY CLINIC OF DOOR COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 RHODE ISLAND ST
STURGEON BAY WI
54235-1424
US

IV. Provider business mailing address

1623 RHODE ISLAND ST P.O. BOX 3
STURGEON BAY WI
54235-1424
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-8989
  • Fax: 920-746-8960
Mailing address:
  • Phone: 920-746-8989
  • Fax: 920-746-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number261Q00000X
License Number StateWI

VIII. Authorized Official

Name: DR. PETER SIGMANN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 920-746-8989