Provider Demographics
NPI:1134261522
Name:BOISMENUE, STUART NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:NICHOLAS
Last Name:BOISMENUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S STEVENS ST
Mailing Address - Street 2:P.O. BOX 1216
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3433
Mailing Address - Country:US
Mailing Address - Phone:715-365-4040
Mailing Address - Fax:715-365-4045
Practice Address - Street 1:138 S STEVENS ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3433
Practice Address - Country:US
Practice Address - Phone:715-365-4040
Practice Address - Fax:715-365-4045
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30344400Medicaid
WI23395OtherWI LICENSE NUMBER
WI44101Medicare ID - Type Unspecified
WI23395OtherWI LICENSE NUMBER