Provider Demographics
NPI:1912957457
Name:GEORGEN, RAYMOND FRANK (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:FRANK
Last Name:GEORGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 THEDA CLARK MEDICAL PLZ
Mailing Address - Street 2:SUITE 410
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2721
Mailing Address - Country:US
Mailing Address - Phone:920-725-4527
Mailing Address - Fax:920-725-0991
Practice Address - Street 1:200 THEDA CLARK MEDICAL PLZ
Practice Address - Street 2:SUITE 410
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2721
Practice Address - Country:US
Practice Address - Phone:920-725-4527
Practice Address - Fax:920-725-0991
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI309901208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31596300Medicaid
000071445Medicare PIN
000271445Medicare PIN