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General NPI Number Information
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NPI Number | 1093238347
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Entity Type | Organization
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Legal Business Name | HUDSON PHYSICIANS, S.C
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 840 SPRUCE ST
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City | BALDWIN
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State | WI
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Zip | 54002-3264
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Country | US
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Telephone | 715-531-6800
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Fax | 715-531-6801
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Provider Business Mailing Address
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Address Line | 2651 HILLCREST DR STE 303
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City | HUDSON
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State | WI
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Zip | 54016-9919
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Country | US
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Telephone | 715-531-6800
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Fax | 715-531-6801
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ERNIE WALLIN
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Credential |
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Telephone | 715-531-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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