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Contact Information

MICHAEL L DOUGLAS, MD
1110 BERGSLIEN STREET
BALDWIN, WI54002
 Phone: 715-684-1111
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MICHAEL L DOUGLAS · (Male)

NPI # 1902907454
Status Active
Credentials MD
Entity Individual
Enumeration date 09/26/2006
Last updated 06/10/2025 - About 12 months ago
Sole proprietor 1 No
Identifiers
  • MN License # 39759
  • SD License # 17115
  • WI License # 56257-20
  • WI Medicaid 100062832
  • MN Other 227GD3O BLUE CROSS/BLUE SHIELD
Hospital affiliation(s)
  • BALDWIN AREA MED CTR - (Critical Access)
    730 10TH AVE
    BALDWIN, WI 54002
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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