Basic Information
| Provider Information | |||||||||
| NPI: | 1467406124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOSAL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8201 MISH KO SWEN DRIVE | ||||||||
| Address2: | PO BOX 396 | ||||||||
| City: | CRANDON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545200396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154784300 | ||||||||
| FaxNumber: | 7154784499 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 TOWER DR | ||||||||
| Address2: | DEAN MEDICAL CENTER | ||||||||
| City: | SUN PRAIRIE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535901239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088253008 | ||||||||
| FaxNumber: | 6088253794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 28410-020 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30816900 | 05 | WI | MEDICAID | 3892 | 01 | WI | DEAN HEALTH INSURANCE | OTHER |