Healthcare Provider Details

I. General information

NPI: 1710062716
Provider Name (Legal Business Name): DANIEL L LAVOIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S HERITAGE WOODS DR
APPLETON WI
54915-1408
US

IV. Provider business mailing address

122 E COLLEGE AVE
APPLETON WI
54911-5794
US

V. Phone/Fax

Practice location:
  • Phone: 920-225-7875
  • Fax: 920-993-5003
Mailing address:
  • Phone: 920-996-3264
  • Fax: 920-830-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34702
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: