Organization
SHEBOYGAN REGIONAL ONCOLOGY CENTER, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA LARUE (OFFICE MANAGER)
(920) 457-6750
Entity
Organization
Contact information
Practice address
1222 N 23RD ST, SHEBOYGAN, WI 53081-3171
(920) 457-6800
(920) 457-6824
Mailing address
PO BOX 1127, SHEBOYGAN, WI 53082-1127
(920) 457-6750
(920) 457-8350
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32719000
—
WI
01
—
CH3854
RAILROAD MEDICARE
WI
Enumeration date
11/03/2005
Last updated
04/20/2008
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