=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275660383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEBOYGAN LUNG SPECIALISTS, SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1621 N TAYLOR DR
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-1990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-458-5864
-----------------------------------------------------
Fax | 920-452-5864
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1621 N TAYLOR DR
-----------------------------------------------------
City | SHEBOYGAN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53081-1990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-458-5864
-----------------------------------------------------
Fax | 920-452-5864
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. LOUANN MEYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-458-8060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 36416
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 36416
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------