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NPI Code Detail

MEDICARE: SHELL LAKE CLINIC, LTD

MEDICARE: SHELL LAKE CLINIC, LTD
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
1207Q00000XFamily Medicine Physician61281-20WI

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 : 1508225988
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHELL LAKE CLINIC, LTD
Provider Business Mailing Address
First Line : 105 4TH AVE
Second Line :
City : SHELL LAKE
State : WI
Zip : 54871-4457
Country : US
Telephone Number : 715-468-2711
Fax Number : 715-468-2727
Provider Business Practice Location Address
First Line : 105 4TH AVE
Second Line :
City : SHELL LAKE
State : WI
Zip : 54871-4457
Country : US
Telephone Number : 715-468-2711
Fax Number : 715-468-2727
Authorized Official
Title or Position : PRESIDENT
Name : DR. JEFFREY L. DUNHAM
Credential : M D
Telephone Number : 715-468-2711
Provider Enumeration Date : 02/15/2016
Last Update Date : 02/15/2016

Similar Medicare Providers

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Practice Location Address:
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54871-4457
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54871-4457
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1003474065 — DR. ALEXANDER JERROLD EGGEN DPT
Practice Location Address:
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SHELL LAKE, WI
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1376360610 — MARGARET MARY MUSSFELDT APNP
Practice Location Address:
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Practice Fax: 715-468-2727

Directions to “SHELL LAKE CLINIC, LTD ” Practice Location

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