Individual
PAUL VAN PERNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1625 MAPLE LN, ASHLAND, WI 54806-3768
(715) 685-7500
(715) 682-2481
Mailing address
1625 MAPLE LN, ASHLAND, WI 54806-3768
(715) 685-7500
(715) 682-2481
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21536-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150257300
—
MN
05
—
30197300
—
WI
Enumeration date
07/17/2006
Last updated
05/09/2011
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