Provider Demographics
NPI:1467406124
Name:NOSAL, JAMES M (MD)
Entity Type:Individual
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First Name:JAMES
Middle Name:M
Last Name:NOSAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8201 MISH KO SWEN DRIVE
Mailing Address - Street 2:PO BOX 396
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-0396
Mailing Address - Country:US
Mailing Address - Phone:715-478-4300
Mailing Address - Fax:715-478-4499
Practice Address - Street 1:10 TOWER DR
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1239
Practice Address - Country:US
Practice Address - Phone:608-825-3008
Practice Address - Fax:608-825-3794
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-09-17
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Provider Licenses
StateLicense IDTaxonomies
WI28410-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30816900Medicaid
WI3892OtherDEAN HEALTH INSURANCE
WI080060660Medicare PIN
WI30816900Medicaid
WI038374150Medicare PIN