Provider Demographics
NPI:1558333732
Name:FOWLER, WILLIAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:FOWLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4863 ENCHANTED VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4118
Mailing Address - Country:US
Mailing Address - Phone:877-337-6747
Mailing Address - Fax:877-767-1005
Practice Address - Street 1:1684 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-6406
Practice Address - Country:US
Practice Address - Phone:877-337-6747
Practice Address - Fax:877-767-1005
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33498208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31830900Medicaid
WI002220023Medicare ID - Type UnspecifiedMEDICARE PART B
WI31830900Medicaid