MICHAEL LEE DOUGLAS (NPI# 1902907454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1902907454 |
Entity Type | Individual |
Full Name | MICHAEL LEE DOUGLAS |
Credential | M.D. |
Practice Address |
1110 Bergslien Street Baldwin WI 54002 |
Mailing Address |
1100 Bergslien St Baldwin WI 54002-2600 |
Practice Telephone | 7156841111 |
Mailing Telephone | 7156841111 |
Enumeration Date | 2006-09-26 |
Last Update Date | 2018-03-23 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
56257-20 | WI | Allopathic & Osteopathic Physicians |
N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
39759 | MN | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MN | BLUE CROSS/BLUE SHIELD | 227GD3O | 01 |
Address | Telephone Number | Fax Number |
---|---|---|
100 Freeman Dr, Saint Peter, MN 560823504 | 5079317125 | 5079317126 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437203544 | Michael Kirk Douglas | Counselor | 1303 Kent Avenue, Baltimore, MD 21207-4828 | 2007-01-23 |
1932296373 | Michael Douglas | Internal Medicine | 1920 Gunbarrel Rd, Suite 110, Chattanooga, TN 37421-3100 | 2006-10-06 |
1407853088 | Michael L Douglas | Chiropractor | 4140 Nw 12th St, Lauderhill, FL 33313-5816 | 2005-06-28 |
1497246011 | Michael Douglas II | Case Manager/Care Coordinator | 2116 Justice St, Monroe, LA 71201-3618 | 2018-05-21 |
1639523665 | Michael Stephen Douglas | Anesthesiology | 11234 Anderson St, Department of Anesthesiology, Loma Linda, CA 92354 | 2016-04-15 |
1972908770 | Michael Douglas Jr. | Counselor | 1845 Grandstand Place, Elgin, IL 60123 | 2014-10-23 |
1902169543 | Michael L Douglas | Urology | 425 Bmh Physicians Office Bldg, Maryville, TN 37804 | 2012-06-19 |
1841572856 | Michael Anthony Douglas | Counselor | 4760 Sepulveda Blvd, Culver City, CA 90230-4820 | 2011-09-15 |
1659679785 | Michael L Douglas | Counselor | 1523 N Boston Pl, Tulsa, OK 74106-4103 | 2011-03-14 |
1073736559 | Michael Adam Douglas | Psychologist | 11704 Wilshire Blvd, Suite 255, Los Angeles, CA 90025-1507 | 2007-04-11 |
Street Address |
1110 BERGSLIEN STREET |
City | BALDWIN |
State | WI |
Zip Code | 54002 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477099026 | Nichole Mattison | Radiologic Technologist | 1180 Oak St, Baldwin, WI 54002 | 2017-01-06 |
1497807929 | Dane L Rasmussen | Pharmacist | 840 Main St., Baldwin, WI 54002 | 2007-01-17 |
1114083912 | Douglas Earl Jacot | Chiropractor | 1640 Tenth Avenue, Baldwin, WI 54002 | 2006-12-28 |
1427092196 | Shaima Sulemankhil | Family Medicine | 730 10th Ave., Baldwin, WI 54002 | 2006-06-15 |
1538114079 | Village of Baldwin | Ambulance | 630 Highway 12, Baldwin, WI 54002 | 2006-05-23 |
1861001083 | Marina Cheung Taylor | Physical Therapist | 990 Main Street, Suite #1, Baldwin, WI 54002 | 2020-07-23 |
1497245625 | Meghan Ann Becker | Physical Therapist | 650 Birch St, Baldwin, WI 54002 | 2018-05-14 |
1720599673 | Karli Rae Kerrschneider | Nurse Practitioner | 1100 Bergslien St, Baldwin, WI 54002 | 2017-10-18 |
1730446477 | Brittany Beeson | Family Medicine | 1100 Bergslien St, Baldwin, WI 54002 | 2012-04-19 |
1902108814 | Purdy Family Dentistry | Dentist | 1730 8th Avenue, Baldwin, WI 54002 | 2010-11-29 |
Find all providers in zip 54002 |
Taxonomy Code | 207QG0300X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Specialization | Geriatric Medicine |
A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710486121 | Integrity Senior Health | Family Medicine | 4347 Danbury Ln, Mount Pleasant, WI 53403-4022 | 2018-02-12 |
1508075409 | Jonny Alexander Macias Tejada | Family Medicine | 1020 N 12th St Ste 301, Milwaukee, WI 53233-1308 | 2007-05-21 |
1801888938 | Mary C Ball | Family Medicine | 100 Silverado Dr, Stoughton, WI 53589-5406 | 2005-08-16 |
1790312171 | Sequoia Integrative Medical Services LLC | Family Medicine | 1351 Ontario Rd, Green Bay, WI 54311-8302 | 2020-03-25 |
1275174922 | Leslie Ann Las | Family Medicine | 500 East Veterans Street, Tomah, WI 54660 | 2019-10-03 |
1558795914 | Richard London, M.d., L.L.C. | Family Medicine | 5000 W Chambers St, Milwaukee, WI 53210-1650 | 2013-08-21 |
1255518437 | Galia Paganelli | Family Medicine | 800 West Ave S, La Crosse, WI 54601-8806 | 2008-01-30 |
1235349077 | Ellen Turner Wenberg | Family Medicine | 710 Riverside Dr, Waupaca, WI 54981-1941 | 2007-05-23 |
1295952208 | Michael Stephen Garrity | Family Medicine | 916 Ferry St, La Crosse, WI 54601-4717 | 2007-04-19 |
1437373586 | Tracy L Sherman | Family Medicine | 2219 Garfield St, Two Rivers, WI 54241-2416 | 2007-04-12 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.