Individual
RALPH B FAIRCHILD III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2400 PINE RIDGE BLVD, WAUSAU, WI 54401-7803
(715) 847-2022
Mailing address
2400 PINE RIDGE BLVD, WAUSAU, WI 54401-7803
(715) 847-2022
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
42511
WI
2086S0129X
Vascular Surgery Physician
51703
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34003000
—
WI
01
—
K400235515
MEDICARE
WI
Enumeration date
03/24/2006
Last updated
04/27/2023
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