Healthcare Provider Details

I. General information

NPI: 1619039419
Provider Name (Legal Business Name): FELIPE M AMBAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SOUTH DR.
WINNEBAGO WI
54985-0009
US

IV. Provider business mailing address

1300 SOUTH DR.
WINNEBAGO WI
54985-0009
US

V. Phone/Fax

Practice location:
  • Phone: 920-235-4910
  • Fax: 920-236-2931
Mailing address:
  • Phone: 920-235-4910
  • Fax: 920-236-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number32408
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: