Individual
ALISHA FRANCES FAHLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 COUNTY ROAD B, SHAWANO, WI 54166-7072
(715) 524-2161
(715) 524-8164
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 830-5900
(920) 738-5787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
56539
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001-0104860
MEDICA
—
01
—
1255691515
BCBS
MN
05
—
1255691515
—
MN
01
—
P01224932
RR MEDICARE
—
Enumeration date
05/21/2012
Last updated
09/01/2015
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