NPI 1730162991 · live from the CMS NPI Registry
Agnesian Healthcare INC
Family Medicine in Fond Du Lac, WI. National Provider Identifier 1730162991, active.
NPI record
| NPI | 1730162991 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Family Medicine 207Q00000X |
| Practice location | 420 E Division St, Fond Du Lac, WI 54935 |
| Practice phone | 920-923-7400 |
| Mailing address | 1808 W Beltline Hwy, Madison, WI 53713 |
| Enumerated | November 22, 2005 |
| Last updated | June 5, 2024 |
| Authorized official | Amy Grinnell, Vp-Finance, Cfo |
| Other names | Ssm Health Fond Du Lac Regional Clinic |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist | 152W00000X | — |
| Anesthesiology | 207L00000X | — |
| Dermatology | 207N00000X | — |
| Family Medicine primary | 207Q00000X | — |
| Internal Medicine | 207R00000X | — |
| Obstetrics & Gynecology | 207V00000X | — |
| Ophthalmology | 207W00000X | — |
| Orthopaedic Surgery | 207X00000X | — |
| Otolaryngology | 207Y00000X | — |
| Pediatrics | 208000000X | — |
| Physical Medicine & Rehabilitation | 208100000X | — |
| Surgery | 208600000X | — |
| Urology | 208800000X | — |
| Podiatrist | 213E00000X | — |
| Durable Medical Equipment & Medical Supplies | 332B00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.