| Pai Participant 23 Sc | |
|
1475 Birch Hill Ln Shawano WI 54166-3707 | |
| (715) 526-3161 | |
| Not Available |
| Full Name | Pai Participant 23 Sc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1475 Birch Hill Ln, Shawano, Wisconsin |
| Authorized Official Name and Position | Erin Laird (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4104588713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pai Participant 23 Sc Po Box 639676 Cincinnati OH 45263-9676 Ph: (859) 291-4800 | Pai Participant 23 Sc 1475 Birch Hill Ln Shawano WI 54166-3707 Ph: (715) 526-3161 |
| NPI Number | 1528674801 |
|---|---|
| Provider Enumeration Date | 09/22/2020 |
| Last Update Date | 09/22/2020 |
| Medicare PECOS PAC ID | 5799104972 |
|---|---|
| Medicare Enrollment ID | O20201008000177 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528674801 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Sonali Wilborn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164523247 PECOS PAC ID: 0446317358 Enrollment ID: I20191021003111 |
Shawano County Health Department Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 311 N Main St Rm 7, Shawano, WI 54166 Phone: 715-526-4808 Fax: 715-524-5792 | |
Thedacare Physicians Shawano Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 117 E Green Bay St, Shawano, WI 54166 Phone: 920-996-3298 | |
Thedacare Medical Center - Shawano, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 100 County Road B, Shawano, WI 54166 Phone: 715-524-2161 Fax: 715-524-8164 |