Organization
WAUSAU AVIATION MEDICINE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN BRIGHAM BURT III M.D. (OWNER)
(715) 675-5371
Entity
Organization
Contact information
Practice address
915 WOODS PLACE, WAUSAU, WI 54403-7074
(715) 675-5371
(715) 675-5381
Mailing address
PO BOX 477, WAUSAU, WI 54402-0477
(715) 675-5371
(715) 675-5381
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27936
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201533595018
ANTHEM BCBS
WI
05
—
21286900
—
WI
Enumeration date
02/20/2007
Last updated
03/15/2016
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