Individual
MICHAEL JASON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2000 E MILESTONE DR, APPLETON, WI 54913-6701
(920) 731-8131
(920) 832-0444
Mailing address
2000 E MILESTONE DR, APPLETON, WI 54913-6701
(920) 731-8131
(920) 832-0444
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
46688
WI
208600000X
Surgery Physician
Primary
46688-020
WI
Other
Enumeration date
05/05/2006
Last updated
07/22/2025
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