Provider Demographics
NPI:1366778250
Name:MID WISCONSIN EAR, NOSE & THROAT PROFESSIONALS
Entity type:Organization
Organization Name:MID WISCONSIN EAR, NOSE & THROAT PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-845-2423
Mailing Address - Street 1:2715 W FRANK ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2593
Mailing Address - Country:US
Mailing Address - Phone:715-832-0707
Mailing Address - Fax:
Practice Address - Street 1:2600 RIB MOUNTAIN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7196
Practice Address - Country:US
Practice Address - Phone:715-845-2423
Practice Address - Fax:715-845-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37345207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1881631802OtherNPI