360 Medical Group Wisconsin SC
Organization Active NPI Family Medicine Physician · Appleton, WI
NPI 1104750660 · NPPES record last updated Jun 10, 2026
Key facts
- NPI
- 1104750660
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- 360 MEDICAL GROUP WISCONSIN SC
- Practice address
- 2800 E Enterprise Ave Ste 333
Appleton, WI 54913-7889 - Phone
- (551) 372-9260
- NPI assigned
- Jun 10, 2026
- Organization subpart
- No
Authorized official
- Name
- James Villar
- Title
- Administrator
- Phone
- (551) 372-9260
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
2800 E Enterprise Ave Ste 333
Appleton, WI 54913-7889
Mailing address
2800 E Enterprise Ave Ste 333
Appleton, WI 54913-7889
Other providers in Appleton, WI
- 601 Briarcliff Drive Operating Company, LLC
- 725 Knapp St Operating Company, LLC
- 920 Wellness Studio LLC
- A Single Step, LLC
- A Village LLC
All providers in Appleton, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.