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General NPI Number Information
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NPI Number | 1255334330
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Entity Type | Individual
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Provider Name | DAVID E RESEN MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 8619 EDGEWATER RDG
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City | OMRO
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State | WI
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Zip | 54963-9760
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Country | US
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Telephone | 920-376-1256
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 43
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City | GREEN LAKE
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State | WI
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Zip | 54941-0043
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Country | US
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Telephone | 920-376-1255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 32951
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License Number State | WI
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