Healthcare Provider Details

I. General information

NPI: 1508845827
Provider Name (Legal Business Name): PETER P GINTNER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S CLARK ST
THORP WI
54771-7624
US

IV. Provider business mailing address

1120 PINE ST
STANLEY WI
54768-1297
US

V. Phone/Fax

Practice location:
  • Phone: 715-669-7279
  • Fax: 715-669-5674
Mailing address:
  • Phone: 715-644-5530
  • Fax: 715-644-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number486
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: