Dougherty, Michael D

Dougherty, Michael D is an individual health care provider with primary practice located at 611 Sherman Ave East , Fort Atkinson WI 53538. 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. Dougherty, Michael D can be contacted via phone (920) 568-5330.

Contact Information

Primary practice address
611 Sherman Ave East Fort Atkinson WI 53538
Phone: (920) 568-5330
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 848-023 Wisconsin

Profile Details

NPI number 1932186210
LBN Legal business name Dougherty, Michael D
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 28th, 2005
Last updated Dec 1st, 2021 - about 4 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 1932186210 NPPES
Wisconsin MEDICAID 42962600

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