Organization
MILE BLUFF CLINIC, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL FRONK (ADMINISTRATOR)
(608) 847-5000
Entity
Organization
Contact information
Practice address
28 COMMERCE ST, WISCONSIN DELLS, WI 53965-8293
(608) 545-5888
Mailing address
1040 DIVISION ST, MAUSTON, WI 53948-1931
(608) 847-5000
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41679000
—
WI
Enumeration date
11/15/2007
Last updated
02/26/2008
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