Provider Demographics
NPI:1275955544
Name:KENECHI ANULIGO DBA ALPINE FAMILY MEDICINE & ALLERGY CLINIC
Entity Type:Organization
Organization Name:KENECHI ANULIGO DBA ALPINE FAMILY MEDICINE & ALLERGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KENECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANULIGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-997-0263
Mailing Address - Street 1:PO BOX 2107
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-2107
Mailing Address - Country:US
Mailing Address - Phone:909-997-0263
Mailing Address - Fax:
Practice Address - Street 1:850 STATE HIGHWAY 153 STE CE
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-8294
Practice Address - Country:US
Practice Address - Phone:715-693-2843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53995-020261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center