Healthcare Provider Details

I. General information

NPI: 1235179946
Provider Name (Legal Business Name): RONALD CORTTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MOHAWK DR
TOMAHAWK WI
54487-2274
US

IV. Provider business mailing address

401 W MOHAWK DR
TOMAHAWK WI
54487-2274
US

V. Phone/Fax

Practice location:
  • Phone: 715-453-7200
  • Fax: 715-453-7221
Mailing address:
  • Phone: 715-453-7200
  • Fax: 715-453-7221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34611
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: