Provider Demographics
NPI:1952846982
Name:PRACTICE PARTNERS HEALTHCARE GROUP, S.C.
Entity Type:Organization
Organization Name:PRACTICE PARTNERS HEALTHCARE GROUP, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINCOLN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIKNESS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-870-2120
Mailing Address - Street 1:1434 THELEN FARM TRL
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:WI
Mailing Address - Zip Code:54082-2062
Mailing Address - Country:US
Mailing Address - Phone:941-870-2120
Mailing Address - Fax:941-328-3595
Practice Address - Street 1:1434 THELEN FARM TRL
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:WI
Practice Address - Zip Code:54082-2062
Practice Address - Country:US
Practice Address - Phone:941-870-2120
Practice Address - Fax:941-328-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty