Individual
STEPHEN A MASSICK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8450
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
17064
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12583
DEAN
WI
01
—
17064
TOUCHPOINT
WI
05
—
31075000
—
WI
01
—
39080723604
UNITY
WI
01
—
WI0146
JOHN DEERE
WI
Enumeration date
11/14/2005
Last updated
07/08/2007
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