Individual
DR. CAPRI MARA FILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
464 S SAINT JOSEPH AVE, ARCADIA, WI 54612-1401
(608) 323-3341
Mailing address
464 S SAINT JOSEPH AVE, ARCADIA, WI 54612-1401
(608) 323-3341
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
43268
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005273601
MEDICARE PART B
—
01
—
8HM164
PROVIDER NUMBER FOR MEDICARE
NM
05
—
91934770
—
NM
05
—
H3451
—
NM
01
—
HSZ196
MEDICARE PART B
NM
05
—
K3526
—
NM
Enumeration date
06/05/2007
Last updated
10/15/2012
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