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General NPI Number Information
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NPI Number | 1295093235
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE INSTITUTE OF WISCONSIN
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 1370 PADST FARMS CIRCLE SUITE 345
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4879
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Country | US
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Telephone | 262-200-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 1370 PADST FARMS CIRCLE SUITE 345
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4879
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Country | US
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Telephone | 262-200-2700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT RISE
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Credential |
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Telephone | 262-200-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2772820
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License Number State | WI
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