Provider Demographics
NPI:1083694111
Name:FERGUS, TODD S (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:S
Last Name:FERGUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1727 SHAWANO AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3273
Mailing Address - Country:US
Mailing Address - Phone:920-496-8877
Mailing Address - Fax:920-496-3061
Practice Address - Street 1:1727 SHAWANO AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3273
Practice Address - Country:US
Practice Address - Phone:920-496-8877
Practice Address - Fax:920-496-3061
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI47587-020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00606706OtherRAILROAD MEDICARE
WI34684700Medicaid
WI34684700Medicaid
BF8745373OtherDEA
WI34684700Medicaid
WI039907125Medicare PIN