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NPI Code Detail

MEDICARE: CENTRAL WISCONSIN RADIATION ONCOLOGY, S.C.

MEDICARE: CENTRAL WISCONSIN RADIATION ONCOLOGY, S.C.
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
12085R0001XRadiation Oncology Physician

General Provider Information

NPI Number : 1144247941
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL WISCONSIN RADIATION ONCOLOGY, S.C.
Provider Business Mailing Address
First Line : 200 E WASHINGTON ST
Second Line : P O BOX 8031
City : APPLETON
State : WI
Zip : 54911-5490
Country : US
Telephone Number : 800-236-1428
Fax Number : 920-739-0124
Provider Business Practice Location Address
First Line : 480 E DIVISION ST
Second Line :
City : FOND DU LAC
State : WI
Zip : 54935-3734
Country : US
Telephone Number : 920-926-4100
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. HONG CHU WANG
Credential : M.D.
Telephone Number : 920-926-4100
Provider Enumeration Date : 07/16/2006
Last Update Date : 08/22/2020

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