Individual
MR. MICHAEL WILLIAM PROBST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
16985 W BLUEMOUND RD, BROOKFIELD, WI 53005-5909
(262) 641-8400
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(262) 641-8400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002144
IA
363A00000X
Physician Assistant
Primary
3323
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100038627
—
WI
Enumeration date
09/08/2010
Last updated
10/15/2023
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