Individual
DR. CHARLES E LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
FLCI, W10237 LAKE EMILY RD, FOX LAKE, WI 54935-8525
(920) 928-6958
(920) 928-6951
Mailing address
W4455 OVERLAND TRL, FOND DU LAC, WI 54935-8525
(920) 924-9630
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
26821
WI
Other
Enumeration date
02/15/2007
Last updated
07/08/2007
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