Provider Demographics
NPI:1336204643
Name:HUIBREGTSE, CHARLES ALBERT (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALBERT
Last Name:HUIBREGTSE
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Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:1600 COUNTY RD EE
Mailing Address - City:REDGRANITE
Mailing Address - State:WI
Mailing Address - Zip Code:54970-0900
Mailing Address - Country:US
Mailing Address - Phone:920-566-3167
Mailing Address - Fax:920-566-3166
Practice Address - Street 1:1600 COUNTY RD EE
Practice Address - Street 2:REDGRANITE CORRECTIONAL INSTITUTION
Practice Address - City:REDGRANITE
Practice Address - State:WI
Practice Address - Zip Code:54970-0900
Practice Address - Country:US
Practice Address - Phone:920-566-3167
Practice Address - Fax:920-566-3166
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WI41116-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine