Provider Demographics
NPI:1376748657
Name:SHEBOYGAN HEALING ARTS SC
Entity Type:Organization
Organization Name:SHEBOYGAN HEALING ARTS SC
Other - Org Name:SHEBOYGAN HEALING ARTS SC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAATKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-459-8475
Mailing Address - Street 1:1320 N TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3042
Mailing Address - Country:US
Mailing Address - Phone:920-459-8475
Mailing Address - Fax:920-694-0437
Practice Address - Street 1:1320 N TAYLOR DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3042
Practice Address - Country:US
Practice Address - Phone:920-459-8475
Practice Address - Fax:920-694-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1972012305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32887700Medicaid
WI32887700Medicaid
WVT63180Medicare UPIN