Active NPI
Stephen Charles Paulk, MD
- Surgery Physician
- Friendship, WI
National Provider Identifier
1467446492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 36262-20
- Practice address
- 402 W Lake St
Friendship, WI 53934-9699 - Phone
- (608) 339-3331
- Fax
- (608) 339-9385
- NPI assigned
- Sep 6, 2005
- Last updated
- Sep 14, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 36262 | WI | |
| Surgery Physician | 208600000X | 36262-20 | WI | Primary |
Addresses
Primary practice location
402 W Lake St
Friendship, WI 53934-9699
Mailing address
402 W Lake St
Friendship, WI 53934-9699
Phone (608) 339-3331
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467446492 | Medicaid | WI | |
| 32109900 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36262 | WI | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347580800000",
"number": "1467446492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "402 W LAKE ST",
"city": "FRIENDSHIP",
"state": "WI",
"postal_code": "539349699",
"telephone_number": "608-339-3331",
"fax_number": "608-339-9385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 W LAKE ST",
"city": "FRIENDSHIP",
"state": "WI",
"postal_code": "539349699",
"telephone_number": "608-339-3331",
"fax_number": "608-339-9385"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAULK",
"first_name": "STEPHEN",
"middle_name": "CHARLES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-06",
"last_updated": "2012-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WI",
"license": "36262",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "36262-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1467446492",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32109900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Friendship, WI
- Moundview Memorial Hospital & Clinics, Inc. (Gundersen Moundview Hospital and Clinics, Inc.)
- Moundview Memorial Hospital and Clinics, Inc. (Gundersen Moundview Hospital and Clinics, Inc.)
- Thao TP Nguyen, DO
- Linda L Noble, CSAC, ICADC
- Sheryl J. Obernberger, NP
- Jennifer Pavloski, AP SOCIAL WORKER
- Phillips Roche a Cri Clinic Pharmacy Inc (Phillips Roche a Cri Pharmacy Inc)
- R & J Medical Transportation Inc
- Jon D Rawling, MD
- Roche a Cri Clinic SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.