Individual
MR. STANLEY FUDALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 MCMILLEN STREET, FORT ATKINSON, WI 53538-1263
(950) 563-5571
(920) 563-4228
Mailing address
500 MCMILLEN ST, FORT HEALTHCARE, FORT ATKINSON, WI 53538-1233
(920) 563-5571
(920) 563-4228
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
41002-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34449000
—
WI
Enumeration date
02/23/2006
Last updated
07/21/2022
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