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Contact Information

MICHAEL D DOUGHERTY, PA
611 SHERMAN AVE EAST
FORT ATKINSON, WI53538
 Phone: 920-568-5330
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for MICHAEL D DOUGHERTY · (Male)

NPI Number 1932186210
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 12/28/2005
Last updated 12/01/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 848-023
  • WI Medicaid 42962600
Hospital affiliation(s) Not Available
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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