Organization
EAU CLAIRE MEDICAL CLINIC, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTON I KIDESS MD (DIRECTOR)
(715) 839-9280
Entity
Organization
Contact information
Practice address
703 W HAMILTON AVE, EAU CLAIRE, WI 54701-6938
(715) 839-9280
(715) 839-9348
Mailing address
703 W HAMILTON AVE, EAU CLAIRE, WI 54701-6938
(715) 839-9280
(715) 839-9348
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36203500
—
WI
01
—
P00374505
RAILROAD MEDICARE
—
Enumeration date
11/14/2011
Last updated
11/14/2011
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