Organization · NPI-2

360 Medical Group Wisconsin Sc

Family Medicine · Appleton, WI

NPI number1104750660
StatusActive
Last updated in NPPESJun 10, 2026

Details

NPI
1104750660
Entity type
Organization (NPI-2)
Legal business name
360 Medical Group Wisconsin Sc
Organization subpart
No
Enumeration date
Jun 10, 2026
Certification date
Jun 10, 2026
Last updated
Jun 10, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Practice location

2800 E Enterprise Ave Ste 333
Appleton, WI 54913-7889

Phone 551-372-9260

Mailing address

2800 E Enterprise Ave Ste 333
Appleton, WI 54913-7889

Authorized official

James Villar
Administrator
5513729260

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