Individual
MICHAEL T CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-4600
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
299
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003022
TOUCHPOINT
WI
01
—
13832
DEAN
WI
05
—
42962500
—
WI
01
—
P00207613
RAILROAD MEDICARE
WI
Enumeration date
11/02/2005
Last updated
07/08/2007
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