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NPI Code Detail

MEDICARE: RICK WOODWARD PA

MEDICARE: RICK WOODWARD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant942-023WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114912169
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICK WOODWARD PA
Provider Business Mailing Address
First Line : 34700 VALLEY RD
Second Line :
City : OCONOMOWOC
State : WI
Zip : 53066-4500
Country : US
Telephone Number : 262-646-4411
Fax Number :
Provider Business Practice Location Address
First Line : 34700 VALLEY RD
Second Line :
City : OCONOMOWOC
State : WI
Zip : 53066-4500
Country : US
Telephone Number : 800-767-4411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2005
Last Update Date : 03/22/2024

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Directions to “ RICK WOODWARD PA” Practice Location

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