Provider Demographics
NPI:1508059809
Name:WISCONSIN GASTROENTEROLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WISCONSIN GASTROENTEROLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-3880
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:STE. 250
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-3880
Mailing Address - Fax:906-225-4523
Practice Address - Street 1:2251 N SHORE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8360
Practice Address - Country:US
Practice Address - Phone:906-225-3880
Practice Address - Fax:906-225-4523
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.P. DIGESTIVE DISEASE ASSOC., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-21
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty