Basic Information
| Provider Information | |||||||||
| NPI: | 1699801316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERKINS | ||||||||
| FirstName: | RICK | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ASPIRUS CREDENTIALING | ||||||||
| Address2: | P.O. BOX 8004 | ||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472000 | ||||||||
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| Practice Location | |||||||||
| Address1: | ASPIRUS GENERAL CLINIC | ||||||||
| Address2: | 110 EAST 5TH AVENUE | ||||||||
| City: | ANTIGO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156232351 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207V00000X | 33903 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | BP2201399 | 01 | WI | DEA NUMBER | OTHER | 33903 | 01 | WI | STATE LICENSE | OTHER | 31887200 | 05 | WI | MEDICAID |