Healthcare Provider Details

I. General information

NPI: 1164435079
Provider Name (Legal Business Name): MICHEL P GELINAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 3RD AVE
WOODRUFF WI
54568-1520
US

IV. Provider business mailing address

7066 HWY J
ST GERMAIN WI
54558
US

V. Phone/Fax

Practice location:
  • Phone: 715-356-2262
  • Fax: 715-356-2257
Mailing address:
  • Phone: 715-479-3406
  • Fax: 715-356-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number39723
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: