Individual
DR. WILLIAM RUSSELL PINKONSLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
N2934 HIGHWAY 22, WAUTOMA, WI 54982
(920) 787-4613
Mailing address
1300 SOUTH DRIVE, PO BOX 0009, WINNEBAGO, WI 54985
(920) 235-4910
(920) 237-2043
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
48295
WI
207Q00000X
Family Medicine Physician
48295
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4136296002
UHC MA DIAMOND PROV #
WI
05
—
43523600
—
WI
01
—
47763
NETWORK HEALTH PROV #
WI
01
—
48295
STATE LICENSE #
WI
01
—
P00252127
RR MEDICARE PROV #
WI
Enumeration date
09/04/2006
Last updated
07/21/2016
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