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Organization
WATERTOWN FAMILY PRACTICE ASSOCIATES S.C.
Active
Organization
WATERTOWN FAMILY PRACTICE ASSOCIATES S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E SULLIVAN M.D. (CLINIC PRESIDENT)
(920) 261-8500
Entity
Organization
Contact information
Practice address
127 HOSPITAL DR, WATERTOWN, WI 53098-3303
(920) 261-8500
Mailing address
127 HOSPITAL DR, WATERTOWN, WI 53098-3303
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32687900
—
WI
Enumeration date
11/30/2006
Last updated
04/07/2022
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