Healthcare Provider Details

I. General information

NPI: 1124077839
Provider Name (Legal Business Name): MARK E. DEYO-SVENDSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 STOUT RD
MENOMONIE WI
54751
US

IV. Provider business mailing address

PO BOX 1510
EAU CLAIRE WI
54702-1510
US

V. Phone/Fax

Practice location:
  • Phone: 715-235-5531
  • Fax: 715-233-7645
Mailing address:
  • Phone: 715-235-5531
  • Fax: 715-233-7645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28691
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27444-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: