Organization
BUTTE DES MORTS PATHOLOGY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER V PODLUSKY M.D. (PRESIDENT)
(920) 738-2000
Entity
Organization
Contact information
Practice address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 738-2000
Mailing address
200 E WASHINGTON ST, P O BOX 8031, APPLETON, WI 54911-5490
(800) 236-8252
(920) 739-0124
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32881300
—
WI
Enumeration date
05/11/2006
Last updated
08/22/2020
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