Healthcare Provider Details

I. General information

NPI: 1972582948
Provider Name (Legal Business Name): RICHARD S ENGELMEIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WIND RIDGE DR
WAUSAU WI
54401-4173
US

IV. Provider business mailing address

500 WIND RIDGE DR
WAUSAU WI
54401-4173
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2611
  • Fax: 715-847-2465
Mailing address:
  • Phone: 715-847-2611
  • Fax: 715-847-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number27449
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: