Organization
WISCONSIN UPPER PENINSULA ONCOLOGY MANAGEMENT SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN CARLSON (MANAGER)
(715) 735-8016
Entity
Organization
Contact information
Practice address
3100 SHORE DR, MARINETTE, WI 54143-4242
(715) 735-6523
Mailing address
3100 SHORE DR, ST. VINCENT HOSPITAL, MARINETTE, WI 54143-4242
(715) 735-6523
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32800100
—
WI
Enumeration date
06/24/2006
Last updated
07/25/2014
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