Healthcare Provider Details

I. General information

NPI: 1295042711
Provider Name (Legal Business Name): YOMEX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 W FOND DU LAC AVE
MILWAUKEE WI
53205-1228
US

IV. Provider business mailing address

1626 W FOND DU LAC AVE
MILWAUKEE WI
53205-1228
US

V. Phone/Fax

Practice location:
  • Phone: 414-326-9034
  • Fax: 414-763-2305
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 StateWI
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number949-25
License Number StateWI

VIII. Authorized Official

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