Charles R Nicolosi M.d.

NPI #1366627895 in La Crosse, Wisconsin

Provider Information

NPI Number: 1366627895
Entity Type: Organization
Organization Name: Charles R Nicolosi M.d.
Primary Specialty: Specialist
Enumeration Date: Jan 3, 2008
Last Updated: Jan 3, 2008

Practice Location

Address: 2031 32ND ST S
City: La Crosse
State: Wisconsin
ZIP Code: 54601-7099
Phone: (608) 788-8103

Authorized Official

Name: CHARLES R NICOLOSI, MD
Title: OWNER
Phone: (608) 788-8103

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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