MICHAEL LEE DOUGLAS


Address: 1110 Bergslien Street, Baldwin, WI 54002
Phone: 7156841111

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
MN BLUE CROSS/BLUE SHIELD 227GD3O 01

Provider Secondary Practice Location

Address Telephone Number Fax Number
100 Freeman Dr, Saint Peter, MN 560823504 5079317125 5079317126

Other Providers MICHAEL DOUGLAS

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

Office Location

Street Address 1110 BERGSLIEN STREET
City BALDWIN
State WI
Zip Code 54002

Providers in the same zip code

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 Information

Taxonomy Code 207QG0300X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine
Specialization Geriatric Medicine

Taxonomy Definition

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.

Providers in the same taxonomy and state

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

Competitor

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City BALDWIN
Zip Code 54002

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Dataset Information

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.

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