Healthcare Provider Details

I. General information

NPI: 1316947559
Provider Name (Legal Business Name): ANTHONY MACASAET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S MAIN ST
VIROQUA WI
54665-2059
US

IV. Provider business mailing address

507 S MAIN ST
VIROQUA WI
54665-2059
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-4230
  • Fax: 608-637-4214
Mailing address:
  • Phone: 608-637-4230
  • Fax: 608-637-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-096087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: