Basic Information
| Provider Information | |||||||||
| NPI: | 1447428321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLGAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1510 | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547021510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087850940 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1221 WHIPPLE ST | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158385222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2008 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 57581 | WI | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 51083 | MN | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 103829 | MN | N | Allopathic & Osteopathic Physicians | Dermatology | 207R00000X | 2578 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207ND0101X | 57581 | WI | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.