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General NPI Number Information
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NPI Number | 1457317273
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Entity Type | Organization
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Legal Business Name | KAUKAUNA CLINIC, S.C.
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 305 E 12TH ST
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City | KAUKAUNA
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State | WI
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Zip | 54130-2865
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Country | US
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Telephone | 920-766-4656
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Fax | 920-766-4659
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Provider Business Mailing Address
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Address Line | 305 E 12TH ST
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City | KAUKAUNA
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State | WI
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Zip | 54130-2865
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Country | US
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Telephone | 920-766-4656
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Fax | 920-766-4659
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL RUSSO
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Credential | MD
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Telephone | 920-766-4656
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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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