Individual
MICHAEL L DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
36500 AURORA DR, SUMMIT, WI 53066-4899
(262) 434-1000
Mailing address
36500 AURORA DR, SUMMIT, WI 53066-4899
(262) 434-1000
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
209-17
WI
Other
Enumeration date
03/22/2022
Last updated
04/14/2022
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