Individual
STEPHEN CHARLES PAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
402 W LAKE ST, FRIENDSHIP, WI 53934-9699
(608) 339-3331
(608) 339-9385
Mailing address
402 W LAKE ST, FRIENDSHIP, WI 53934-9699
(608) 339-3331
(608) 339-9385
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36262
WI
208600000X
Surgery Physician
Primary
36262-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467446492
—
WI
05
—
32109900
—
WI
Enumeration date
09/06/2005
Last updated
09/14/2012
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