Individual
EDWARD S SCANLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1550 MIDWAY PL, MENASHA, WI 54952-1165
(920) 727-5633
Mailing address
1570 MIDWAY PL, MENASHA, WI 54952-1165
(920) 727-5633
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18464
WI
207RC0000X
Cardiovascular Disease Physician
18464
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31241900
—
WI
Enumeration date
09/20/2005
Last updated
09/09/2008
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