Organization
CENTRAL WISCONSIN ANESTHESIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY MORAN M.D. (PRESIDENT)
(715) 845-5505
Entity
Organization
Contact information
Practice address
425 PINE RIDGE BOULEVARD, SUITE 211, WAUSAU, WI 54401
(715) 845-5505
(715) 848-2884
Mailing address
425 PINE RIDGE BOULEVARD, SUITE 211, WAUSAU, WI 54401
(715) 845-5505
(715) 848-2884
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000039110
HUMANA GOLD MEDICARE
WI
01
—
43411800
MANAGED HEALTH CARE
WI
05
—
43411800
—
WI
01
—
C01751
MEDICARE RAILROAD GROUP
WI
Enumeration date
07/07/2006
Last updated
05/03/2018
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