Individual
MICHAEL D DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
611 SHERMAN AVE EAST, FORT ATKINSON, WI 53538
(920) 568-5330
Mailing address
6400 INDUSTRIAL LOOP, GREENDALE, WI 53129-2452
(414) 423-4100
(414) 423-4134
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
848-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42962600
—
WI
Enumeration date
12/28/2005
Last updated
12/01/2021
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