Individual
MICHAEL R. VICENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
220 WASHINGTON AVE, OSHKOSH, WI 54901-5030
(920) 236-4700
(920) 236-1157
Mailing address
220 WASHINGTON AVE, OSHKOSH, WI 54901-5030
(920) 236-4700
(920) 236-1157
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
40821
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000771090
MEDICARE PTAN
WI
05
—
32562200
—
WI
Enumeration date
07/27/2006
Last updated
03/27/2023
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