Individual
MARK HALLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 E GRANT ST, APPLETON, WI 54911-3483
(920) 831-5050
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3298
(920) 738-5787
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
34228
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31944600
—
WI
Enumeration date
07/20/2006
Last updated
02/02/2011
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