Healthcare Provider Details

I. General information

NPI: 1841496619
Provider Name (Legal Business Name): ANDREW ARTHUR MAES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEMORIAL DR STE 2010
BERLIN WI
54923-1243
US

IV. Provider business mailing address

122 E COLLEGE AVE
APPLETON WI
54911-5794
US

V. Phone/Fax

Practice location:
  • Phone: 920-361-5975
  • Fax: 920-361-6339
Mailing address:
  • Phone: 920-996-3264
  • Fax: 920-830-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number60682-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: