Provider Demographics
NPI:1245258334
Name:STORCH, TODD D (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:STORCH
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:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-0326
Mailing Address - Country:US
Mailing Address - Phone:715-341-7920
Mailing Address - Fax:715-341-0776
Practice Address - Street 1:500 VINCENT ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1848
Practice Address - Country:US
Practice Address - Phone:715-341-7920
Practice Address - Fax:715-341-0776
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33208 020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32458200Medicaid
G75101Medicare UPIN