Healthcare Provider Details

I. General information

NPI: 1518999648
Provider Name (Legal Business Name): CENTRAL WISCONSIN ANESTHESIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PINE RIDGE BOULEVARD SUITE 211
WAUSAU WI
54401
US

IV. Provider business mailing address

425 PINE RIDGE BOULEVARD SUITE 211
WAUSAU WI
54401
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-5505
  • Fax: 715-848-2884
Mailing address:
  • Phone: 715-845-5505
  • Fax: 715-848-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY MORAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 715-845-5505