=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699719476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WISCONSIN MICHIGAN PHYSICIANS, SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 10/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 ROOSEVELT RD
-----------------------------------------------------
City | NIAGARA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54151-1043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-225-1780
-----------------------------------------------------
Fax | 715-251-1787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 ROOSEVELT RD PO BOX 6
-----------------------------------------------------
City | NIAGARA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54151-1043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-251-1780
-----------------------------------------------------
Fax | 715-251-1787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | DR. FRANCOISE SINGH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 888-724-6377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 746200001
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 34886
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------