Individual
COREY STEPHAN MACRANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3916 N INTERTECH CT, APPLETON, WI 54913-6957
(920) 996-1000
Mailing address
3916 N INTERTECH CT, APPLETON, WI 54913-6957
(920) 996-1000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
72866-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2018
Last updated
07/22/2021
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