Provider Demographics
NPI:1790770550
Name:ROELLI, MICHELE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:A
Last Name:ROELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:NORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MEMORIAL HSOPITAL OF LAFAYETTE COUNTY
Mailing Address - Street 2:800 CLAY ST
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1228
Mailing Address - Country:US
Mailing Address - Phone:608-776-4466
Mailing Address - Fax:608-776-5777
Practice Address - Street 1:MEMORIAL HOSPITAL OF LAFAYETTE COUNTY
Practice Address - Street 2:800 CLAY ST
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1228
Practice Address - Country:US
Practice Address - Phone:608-776-4466
Practice Address - Fax:608-776-5777
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44873-020207Q00000X
WI44873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34346000Medicaid
WI27070-0009Medicare ID - Type Unspecified
WI34346000Medicaid