Basic Information
| Provider Information | |||||||||
| NPI: | 1063790400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOW | ||||||||
| FirstName: | ALBOURY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1680 DIAGONAL RD | ||||||||
| Address2: | |||||||||
| City: | WORTHINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 561871008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073723800 | ||||||||
| FaxNumber: | 5073723806 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 PARKER ST | ||||||||
| Address2: | |||||||||
| City: | BOSCOBEL | ||||||||
| State: | WI | ||||||||
| PostalCode: | 538051642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083754112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2011 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 58686 | MN | N | Other Service Providers | Specialist | 207Q00000X | 58686 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 68062 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.