Individual
DR. TIMOTHY S MOLOGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2105 E ENTERPRISE AVE # 111, APPLETON, WI 54913
(920) 731-6611
(920) 731-6732
Mailing address
2105 E ENTERPRISE AVE # 111, APPLETON, WI 54913-7862
(920) 731-6611
(920) 731-6732
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
46236
WI
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
46236
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
391821816017
BC/BS
WI
Enumeration date
07/26/2006
Last updated
09/14/2021
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