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NPI Code Detail

MEDICARE: INTERNAL MEDICINE & PEDIATRICS, S.C.

MEDICARE: INTERNAL MEDICINE & PEDIATRICS, 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
1207R00000XInternal Medicine Physician
2208000000XPediatrics Physician

General Provider Information

NPI Number : 1770558066
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERNAL MEDICINE & PEDIATRICS, S.C.
Provider Business Mailing Address
First Line : 500 MCMILLEN ST
Second Line :
City : FORT ATKINSON
State : WI
Zip : 53538-1233
Country : US
Telephone Number : 920-563-7711
Fax Number : 920-563-7705
Provider Business Practice Location Address
First Line : 500 MCMILLEN ST
Second Line :
City : FORT ATKINSON
State : WI
Zip : 53538-1233
Country : US
Telephone Number : 920-563-7711
Fax Number : 920-563-7705
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. THERESANNE JOHNSON
Credential :
Telephone Number : 920-563-7711
Provider Enumeration Date : 02/21/2006
Last Update Date : 09/11/2025

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Directions to “INTERNAL MEDICINE & PEDIATRICS, S.C. ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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