Carlson, Ethan W

Carlson, Ethan W is an individual health care provider with primary practice located at 1700 Tuttle St , Baraboo WI 53913-3319. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Carlson, Ethan W can be contacted via phone (608) 355-3800.

Contact Information

Primary practice address
1700 Tuttle St Baraboo WI 53913-3319
Phone: (608) 355-3800
Fax: (608) 355-7001
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 37699-020 Wisconsin

Profile Details

NPI number 1265498588
LBN Legal business name Carlson, Ethan W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2006
Last updated Nov 4th, 2020 - about 4 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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Identifiers

StateTypeNumberIssuer
All States NPI 1265498588 NPPES
Wisconsin MEDICAID 1265498588

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