Provider Demographics
NPI:1346243821
Name:POSER, SAMUEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:G
Last Name:POSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 PARK AVE.
Mailing Address - Street 2:P.O. BOX 229
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925
Mailing Address - Country:US
Mailing Address - Phone:920-623-5000
Mailing Address - Fax:920-623-0519
Practice Address - Street 1:635 PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-2604
Practice Address - Country:US
Practice Address - Phone:920-623-5000
Practice Address - Fax:920-623-0519
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27371 020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30675800Medicaid
WI000013017Medicare ID - Type Unspecified
WI30675800Medicaid