Basic Information
| Provider Information | |||||||||
| NPI: | 1780688317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORDZRO | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 E DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | FOND DU LAC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549354560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209268340 | ||||||||
| FaxNumber: | 9209268370 | ||||||||
| Practice Location | |||||||||
| Address1: | 845 PARKSIDE ST | ||||||||
| Address2: | |||||||||
| City: | RIPON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549718505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803238460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 26433 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 67166 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02100289 | 05 | MS | MEDICAID | BT8479518 | 01 | DEA | OTHER |