Carlson, Michael T

Carlson, Michael T is an individual health care provider with primary practice located at 430 E Division St , Fond Du Lac WI 54935-4560. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Carlson, Michael T can be contacted via phone (920) 926-4600.

Contact Information

Primary practice address
430 E Division St Fond Du Lac WI 54935-4560
Phone: (920) 926-4600
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 299 Wisconsin

Profile Details

NPI number 1780675462
LBN Legal business name Carlson, Michael T
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Jul 8th, 2007 - about 18 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 1780675462 NPPES
Wisconsin Other 13832 DEAN
Wisconsin Other P00207613 DEAN
Wisconsin Other 1003022 DEAN
Wisconsin MEDICAID 42962500 DEAN

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