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Specialty details in registry · Sparta, WI

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At a glance

331 S Water St, Sparta, WI 54656-1726

NPPES record updated Feb 17, 2015. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

331 S Water St
Sparta, WI 54656-1726
Professional details: NPI, taxonomy & registry record
NPI1033500731
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
313M00000X
Enumeration date
Feb 17, 2015
Record updated
Feb 17, 2015
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

313M00000X · Primary

License reported: 92-19 WI

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

331 S Water St
Sparta, WI 54656-1726
Phone
(608) 366-6256
Mailing address
331 S WATER ST

SPARTA, WI 546561726
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

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