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NPI Code Detail

MEDICARE: MICHAEL L FERNETTE CADC III

MEDICARE: MICHAEL L FERNETTE CADC III
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1839WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110705OTHERWIDEAN HEALTH PLANS
239396100OTHERWIHIRSP
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346271541
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL L FERNETTE CADC III
Provider Business Mailing Address
First Line : 200 W ALONA LN
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2202
Country : US
Telephone Number : 608-723-6357
Fax Number : 608-723-4417
Provider Business Practice Location Address
First Line : 200 W ALONA LN
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2202
Country : US
Telephone Number : 608-723-6357
Fax Number : 608-723-4417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 07/07/2008

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