Provider Demographics
NPI:1942288154
Name:KEUTZER, WILLIAM J (PAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:KEUTZER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1206
Mailing Address - Country:US
Mailing Address - Phone:920-846-0530
Mailing Address - Fax:
Practice Address - Street 1:127 N HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1206
Practice Address - Country:US
Practice Address - Phone:920-846-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1828-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P34951Medicare UPIN
WI42875500Medicare ID - Type Unspecified