Provider Demographics
NPI:1447232624
Name:MICHAEL D PLOOSTER MD SC
Entity Type:Organization
Organization Name:MICHAEL D PLOOSTER MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DWAIN
Authorized Official - Last Name:PLOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-356-3942
Mailing Address - Street 1:635 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1502
Mailing Address - Country:US
Mailing Address - Phone:608-356-3942
Mailing Address - Fax:608-356-6047
Practice Address - Street 1:635 15TH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1502
Practice Address - Country:US
Practice Address - Phone:608-356-3942
Practice Address - Fax:608-356-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41751000Medicaid
WI0676320001Medicare NSC