Bacchus, Austin Frank

Bacchus, Austin Frank is an individual health care provider with primary practice located at 146 E Geneva Sq , Lake Geneva WI 53147-9694. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bacchus, Austin Frank can be contacted via phone (262) 249-4660.

Contact Information

Primary practice address
146 E Geneva Sq Lake Geneva WI 53147-9694
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 50490 Wisconsin

Profile Details

NPI number 1225258171
LBN Legal business name Bacchus, Austin Frank
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2007
Last updated Dec 3rd, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225258171 NPPES
Wisconsin MEDICAID 34790900

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