Provider Demographics
NPI:1467519801
Name:SAUK PRAIRIE INTERNAL MEDICINE, LTD.
Entity Type:Organization
Organization Name:SAUK PRAIRIE INTERNAL MEDICINE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ENSMINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:608-643-2471
Mailing Address - Street 1:35 PRAIRIE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1500
Mailing Address - Country:US
Mailing Address - Phone:608-643-2471
Mailing Address - Fax:608-643-4788
Practice Address - Street 1:35 PRAIRIE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1500
Practice Address - Country:US
Practice Address - Phone:608-643-2471
Practice Address - Fax:608-643-4788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36639-21207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI57170Medicare ID - Type UnspecifiedSAUK CO.
WI15150Medicare ID - Type UnspecifiedDANE CO.