Individual
GARY EDELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
902 RIVERSIDE DR, WAUPACA, WI 54981-1992
(715) 258-1160
(715) 256-3079
Mailing address
710 RIVERSIDE DR, WAUPACA, WI 54981-1941
(715) 256-3000
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
30386
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002469010
MEDICARE PTAN
WI
01
—
020052618
RAILROAD MEDICARE
WI
05
—
34265900
—
WI
Enumeration date
07/20/2006
Last updated
01/26/2012
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