Healthcare Provider Details

I. General information

NPI: 1154474252
Provider Name (Legal Business Name): AGAPES ACUPUNCTURE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 REDBIRD CIR
DE PERE WI
54115-8796
US

IV. Provider business mailing address

566 REDBIRD CIR
DE PERE WI
54115-8796
US

V. Phone/Fax

Practice location:
  • Phone: 920-337-9100
  • Fax: 920-337-9101
Mailing address:
  • Phone: 920-337-9100
  • Fax: 920-337-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL ROBERT POLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 920-337-9100