Healthcare Provider Details

I. General information

NPI: 1205965209
Provider Name (Legal Business Name): CHRISTOPHER ROBERT ORGEMAN A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MOHAWK DR SUITE 100
TOMAHAWK WI
54487-2218
US

IV. Provider business mailing address

102 S HUDSON ST
ANTIGO WI
54409-2547
US

V. Phone/Fax

Practice location:
  • Phone: 715-453-7740
  • Fax: 715-453-7717
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number803-039
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: