Individual
DR. SAMUEL B PICONE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
N9781 W DUCK LAKE RD # KTC130, SUMMIT LAKE, WI 54485-9629
(715) 443-4329
(815) 366-3349
Mailing address
PO BOX 130, SUMMIT LAKE, WI 54485-0130
(715) 443-4329
(815) 366-3349
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
33904
WI
208600000X
Surgery Physician
G037968
CA
208600000X
Surgery Physician
MD072888L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31885600
—
WI
Enumeration date
07/08/2006
Last updated
01/06/2014
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