Provider Demographics
NPI:1619040672
Name:ARNOLD, ALICIA CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:CHRISTINE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 W FRANK ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2593
Mailing Address - Country:US
Mailing Address - Phone:715-834-5511
Mailing Address - Fax:715-834-5870
Practice Address - Street 1:2715 W FRANK ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-2593
Practice Address - Country:US
Practice Address - Phone:715-834-5511
Practice Address - Fax:715-834-5870
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2243452085R0202X
WI531982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI202050026OtherMEDICARE PTAN
MN51656OtherMN MEDICAL LICENSE
WI100005237Medicaid
WI550300016OtherMEDICARE PTAN
WI53198OtherWI MEDICAL LICENSE
MN300005227OtherMEDICARE PTAN