Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Pai Participant 23 SC

Organization Geriatric Medicine (Internal Medicine) Physician · NPI 1528674801

Pai Participant 23 SC is a Geriatric Medicine (Internal Medicine) Physician in Shawano, Wisconsin. Registered with an NPI since 2020.

In the registry since
2020
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Practice location Address checks out

1475 Birch Hill Ln
Shawano, WI 54166-3707
Phone: (715) 526-3161
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Internal Medicine) Physician (primary) Taxonomy 207RG0300X

Record details

NPI number1528674801
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Erin Laird — Authorized Official · (410) 458-8713
NPI enumeratedSeptember 22, 2020
Last updated in NPPESSeptember 22, 2020
Certification dateSeptember 22, 2020
Mailing addressPo Box 639676, Cincinnati, OH 45263-9676