Individual
MR. MICHAEL RICKY BUBACZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN, APNP
Contact information
Practice address
7520 WOLF RD, LAKE TOMAHAWK, WI 54539-9487
(715) 277-2848
Mailing address
7520 WOLF RD, LAKE TOMAHAWK, WI 54539-9487
(715) 277-2848
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2806-33
WI
Other
Enumeration date
09/28/2007
Last updated
09/28/2007
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