Black, Michael Jason

Black, Michael Jason is an individual health care provider with primary practice located at 1818 N Meade St Suite 240 West, Appleton WI 54911-3496. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Black, Michael Jason can be contacted via phone (920) 731-8131.

Contact Information

Primary practice address
1818 N Meade St Suite 240 West Appleton WI 54911-3496
Phone: (920) 731-8131
Fax: (920) 832-0444
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 46688 Wisconsin
Allopathic & Osteopathic Physicians / Surgery 208600000X 46688-020 Wisconsin

Profile Details

NPI number 1720036387
LBN Legal business name Black, Michael Jason
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 5th, 2006
Last updated Oct 27th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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