Healthcare Provider Details

I. General information

NPI: 1194123513
Provider Name (Legal Business Name): YOMEX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 W CAPITOL DR
MILWAUKEE WI
53216-2528
US

IV. Provider business mailing address

2525 N MAYFAIR RD SUITE 80
WAUWATOSA WI
53226-1403
US

V. Phone/Fax

Practice location:
  • Phone: 414-444-9242
  • Fax:
Mailing address:
  • Phone: 414-326-9034
  • Fax: 414-763-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MEXTON DEACON
Title or Position: OWNER
Credential: DPM
Phone: 414-326-9034