Basic Information
| Provider Information | |||||||||
| NPI: | 1194055863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SETTERGREN | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | BELOIT CLINIC | ||||||||
| Address2: | 190 S E. HUEBBE PARKWAY | ||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535111842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083642293 | ||||||||
| FaxNumber: | 6083645452 | ||||||||
| Practice Location | |||||||||
| Address1: | BELOIT MEMORIAL HOSPITAL | ||||||||
| Address2: | 1969 W. HART RD | ||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535112230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083635971 | ||||||||
| FaxNumber: | 6083635737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2010 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 038011592 | IL | N | Chiropractic Providers | Chiropractor | 208M00000X | 036153573 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 75081-20 | WI | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 100165664 | 05 | WI | MEDICAID |