Provider Demographics
NPI:1821989872
Name:WESTERN WISCONSIN UROLOGY
Entity type:Organization
Organization Name:WESTERN WISCONSIN UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNSI
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLICKSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-835-6548
Mailing Address - Street 1:3217 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6946
Mailing Address - Country:US
Mailing Address - Phone:715-835-6548
Mailing Address - Fax:715-835-7708
Practice Address - Street 1:3217 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6946
Practice Address - Country:US
Practice Address - Phone:715-835-6548
Practice Address - Fax:715-835-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site