Organization
SHELL LAKE CLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY L DUNHAM MD (PRESIDENT)
(715) 468-2711
Entity
Organization
Contact information
Practice address
105 4TH AVE, SHELL LAKE, WI 54871-0336
(715) 468-2711
(715) 468-2727
Mailing address
105 4TH AVE, P O BOX 336, SHELL LAKE, WI 54871-0336
(715) 468-2711
(715) 468-2727
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32751100
—
WI
Enumeration date
08/29/2006
Last updated
10/23/2008
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