Basic Information
| Provider Information | |||||||||
| NPI: | 1639254022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLAN W. TORKELSON, M.D., S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13111 N PORT WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530972416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629689190 | ||||||||
| FaxNumber: | 2629689119 | ||||||||
| Practice Location | |||||||||
| Address1: | 13111 N PORT WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530972416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622437410 | ||||||||
| FaxNumber: | 2622437482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TORKELSON | ||||||||
| AuthorizedOfficialFirstName: | ALLAN | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2622437410 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 20837 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 30459200 | 05 | WI | MEDICAID |