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General NPI Number Information
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NPI Number | 1467519801
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Entity Type | Organization
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Legal Business Name | SAUK PRAIRIE INTERNAL MEDICINE, LTD.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 35 PRAIRIE AVE SUITE 200
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City | PRAIRIE DU SAC
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State | WI
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Zip | 53578-1500
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Country | US
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Telephone | 608-643-2471
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Fax | 608-643-4788
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Provider Business Mailing Address
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Address Line | 35 PRAIRIE AVE SUITE 200
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City | PRAIRIE DU SAC
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State | WI
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Zip | 53578-1500
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Country | US
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Telephone | 608-643-2471
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Fax | 608-643-4788
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT ALAN ENSMINGER
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Credential | D.O.
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Telephone | 608-643-2471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 36639-21
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License Number State | WI
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