Individual
DR. JUSTIN ERIC PAULSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
970 S SILVER LAKE ST STE 102, OCONOMOWOC, WI 53066-3802
(262) 569-7100
(262) 567-6295
Mailing address
970 S SILVER LAKE ST STE 102, OCONOMOWOC, WI 53066-3802
(262) 569-7100
(262) 567-6295
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
100986-875
WI
2080P0214X
Pediatric Pulmonology Physician
2011-00770
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316112667
—
NC
01
—
19EX0
BCBS NC
NC
Enumeration date
04/28/2008
Last updated
02/23/2024
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