Individual
ETHAN W CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 TUTTLE ST, BARABOO, WI 53913-3319
(608) 355-3800
(608) 355-7001
Mailing address
1700 TUTTLE ST, BARABOO, WI 53913-3319
(608) 355-3800
(608) 355-7001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37699-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265498588
—
WI
Enumeration date
04/25/2006
Last updated
11/04/2020
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